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For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Michele Napier"},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1493.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":821.32,"additional_payer_notes":"APC"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":837.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":2429.0},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":1754.0},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":3066.0}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":485373.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179588.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174200.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":323258.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179588.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":374287.21},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":393007.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179588.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177792.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":181383.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":384571.98},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":277772.9},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":485373.95},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":179588.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":279510.0,"10th_percentile":279510.0,"90th_percentile":279510.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":196266.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72618.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70440.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":130713.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72618.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":151347.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":158917.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72618.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71892.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73344.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":155506.29},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":112320.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":196266.78},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72618.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":149901.63,"10th_percentile":149901.63,"90th_percentile":149901.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":367620.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136019.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131938.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":244834.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136019.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":283483.77},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":297662.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136019.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134659.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137379.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":291273.42},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":210384.18},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":367620.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136019.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":196948.0,"10th_percentile":196948.0,"90th_percentile":320166.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":127364.31,"10th_percentile":127364.31,"90th_percentile":127364.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":176229.83,"10th_percentile":176229.83,"90th_percentile":176229.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":128403.34,"10th_percentile":128403.34,"90th_percentile":128403.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":239906.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86102.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159777.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":184999.3},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":194252.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87877.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89652.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":190082.76},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":137295.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":239906.25},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88765.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":145530.01,"10th_percentile":145530.01,"90th_percentile":145530.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":109248.0,"10th_percentile":109248.0,"90th_percentile":109248.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80312.13,"10th_percentile":80312.13,"90th_percentile":80312.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":125892.0,"10th_percentile":125892.0,"90th_percentile":125892.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":178577.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66073.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64091.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":118932.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66073.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":137707.04},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":144594.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66073.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65412.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66734.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":141490.99},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":102197.68},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":178577.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66073.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":80312.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29715.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28824.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53488.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29715.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":61931.77},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65029.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29715.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29418.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30012.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63633.55},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":45961.94},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":80312.84},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29715.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":224297.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82989.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80500.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":149381.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82989.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":172962.87},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":181613.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82989.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82160.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83819.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":177715.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":128362.38},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":224297.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82989.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":97071.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35916.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34838.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64649.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35916.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":74855.04},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78598.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35916.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35557.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36275.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76911.93},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":55552.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":97071.67},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35916.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":124283.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45984.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44605.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82772.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45984.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":95838.65},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":100632.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45984.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45524.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46444.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98472.13},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":71125.54},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":124283.12},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45984.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":94465.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34952.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33903.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62913.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34952.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":72844.96},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76488.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34952.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34602.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35301.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74846.61},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":54061.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":94465.01},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34952.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":73021.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27017.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26207.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48632.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27017.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":56308.9},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59125.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27017.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26747.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27287.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57856.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":41788.99},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":73021.12},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27017.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":49912.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18467.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17913.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33241.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18467.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":38489.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40414.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18467.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18283.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18652.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39546.94},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":28564.4},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":49912.78},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18467.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8133.6,"10th_percentile":8133.6,"90th_percentile":8133.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":208150.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77015.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74704.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":138627.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77015.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":160511.07},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":168539.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77015.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76245.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77785.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":164921.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":119121.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":208150.03},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77015.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":102702.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37999.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36859.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68399.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37999.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":79197.07},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":83158.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37999.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37619.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38379.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81373.27},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":58775.19},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":102702.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37999.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":94087.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34812.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33767.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34812.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":72553.8},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76182.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34812.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34464.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35160.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74547.45},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":53844.96},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":94087.44},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34812.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":747926.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":276732.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":268430.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":498118.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":276732.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":576749.48},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":605595.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":276732.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273964.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":279499.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":592597.56},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":428027.91},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":747926.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":276732.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":123571.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45721.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44349.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82298.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45721.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":95289.72},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":100055.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45721.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45264.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46178.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97908.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":70718.16},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":123571.27},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45721.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":136287.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48913.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90767.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":105095.69},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":110352.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50426.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49922.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50930.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107983.54},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":77995.55},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":136287.62},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50426.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":91688.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33924.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32907.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61064.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33924.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":70703.99},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74240.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33924.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33585.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34263.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72646.82},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":52472.15},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":91688.62},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33924.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":55032.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20362.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19751.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36651.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20362.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":42437.35},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44559.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20362.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20565.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43603.46},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31494.39},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":55032.57},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20362.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":99248.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36722.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35620.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66099.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36722.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":76533.89},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80361.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36722.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36354.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37089.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78636.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":56798.73},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":99248.8},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36722.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":67754.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25068.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24316.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45124.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25068.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":52247.34},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54860.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25068.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24818.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25319.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53683.0},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":38774.75},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":67754.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25068.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":78748.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29137.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28262.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52446.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29137.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":60725.73},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63762.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29137.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28845.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29428.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62394.36},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":45066.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":78748.84},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29137.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":53851.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19924.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19327.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35864.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19924.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":41526.48},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43603.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19924.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19725.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20124.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42667.55},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":30818.39},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":53851.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19924.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":43696.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16167.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29101.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16167.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":33695.85},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35381.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16167.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16006.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16329.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34621.76},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":25006.98},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":43696.63},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16167.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":104063.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38503.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37348.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69306.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38503.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":80246.85},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84260.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38503.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38118.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82451.9},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":59554.27},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":104063.76},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38503.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":59088.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21862.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21206.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39353.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21862.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":45565.33},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47844.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21862.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22081.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46817.39},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":33815.78},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":59088.91},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21862.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":88635.0,"10th_percentile":88635.0,"90th_percentile":88635.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":38020.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14067.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13645.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25321.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14067.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29319.09},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30785.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14067.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13927.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30124.73},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21758.82},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":38020.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14067.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":77602.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28712.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27851.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51683.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28712.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":59841.56},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62834.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28712.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28425.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28999.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61485.9},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":44410.72},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":77602.26},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28712.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":36908.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13246.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24581.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28461.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29885.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13519.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13792.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29243.71},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21122.47},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36908.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13656.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10336.81,"maximum":28801.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10336.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19181.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22209.69},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23320.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10763.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22819.98},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16482.66},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28801.43},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":67040.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24804.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24060.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44648.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24804.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":51697.07},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54282.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24804.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24556.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25053.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53117.62},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":38366.38},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":67040.52},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24804.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":41403.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15319.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14859.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27574.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15319.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":31927.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33524.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15319.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15166.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15472.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32804.83},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23694.64},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":41403.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15319.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15915.82,"10th_percentile":15915.82,"90th_percentile":15915.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14236.32,"10th_percentile":14236.32,"90th_percentile":14236.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12076.71,"maximum":33649.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12076.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22410.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25948.04},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27245.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12325.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12574.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26661.04},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19257.03},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33649.3},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12450.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12480.0,"10th_percentile":12480.0,"90th_percentile":12480.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12021.21,"10th_percentile":12021.21,"90th_percentile":12021.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":57019.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20464.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37974.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":43969.29},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46168.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20886.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21308.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45177.49},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":32631.3},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":57019.17},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21097.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20949.73,"10th_percentile":20949.73,"90th_percentile":20949.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18520.45,"10th_percentile":18520.45,"90th_percentile":18520.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23635.13,"10th_percentile":23635.13,"90th_percentile":23635.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20773.97,"10th_percentile":20773.97,"90th_percentile":20773.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":28103.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10086.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18716.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21671.45},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22755.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10294.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10502.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22266.94},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16083.21},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28103.43},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10796.31,"10th_percentile":10796.31,"90th_percentile":10796.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22869.0,"10th_percentile":22869.0,"90th_percentile":22869.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10462.45,"10th_percentile":10462.45,"90th_percentile":10462.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11318.8,"10th_percentile":11318.8,"90th_percentile":11319.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":26090.66,"10th_percentile":26090.66,"90th_percentile":26090.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7104.66,"10th_percentile":7104.66,"90th_percentile":7104.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7307.07,"maximum":20359.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7307.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13559.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15699.98},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16485.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7457.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7608.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16131.39},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11651.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20359.66},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7623.0,"10th_percentile":7618.0,"90th_percentile":22869.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7734.07,"10th_percentile":7733.99,"90th_percentile":7738.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8365.41,"10th_percentile":8218.41,"90th_percentile":8671.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7887.39,"10th_percentile":7887.39,"90th_percentile":7887.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":15619.52,"10th_percentile":15619.52,"90th_percentile":15619.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7974.72,"10th_percentile":7735.83,"90th_percentile":7978.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":66875.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24744.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24001.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44539.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24744.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":51570.19},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54149.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24744.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24496.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24991.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52987.25},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":38272.21},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":66875.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24744.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22505.9,"10th_percentile":22505.9,"90th_percentile":22505.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":38081.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14090.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13667.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25362.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14090.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29365.84},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30834.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14090.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13949.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14231.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30172.76},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21793.51},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":38081.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14090.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":29923.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11071.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10739.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19929.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11071.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23075.16},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24229.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11071.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10961.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11182.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23709.23},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17124.96},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29923.76},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11071.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":31371.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11607.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11259.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20893.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11607.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24191.72},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25401.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11607.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11491.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11723.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24856.47},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17953.61},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31371.72},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11607.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":16959.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6275.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6086.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11295.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6275.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13078.2},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13732.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6275.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6212.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6337.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13437.56},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9705.83},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16959.74},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6275.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":26445.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9491.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17612.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20393.28},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21413.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9882.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20953.65},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15134.63},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26445.91},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9784.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11500.0,"10th_percentile":11500.0,"90th_percentile":11500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":17659.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6337.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11761.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13617.78},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14298.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6468.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6599.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13991.97},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10106.28},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17659.47},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":40236.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14440.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26797.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":31027.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32579.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14738.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15036.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31879.9},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23026.57},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":40236.09},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":25859.67,"10th_percentile":25859.67,"90th_percentile":25859.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10167.0,"10th_percentile":10167.0,"90th_percentile":16945.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"1 through 10","median_amount":13827.8,"10th_percentile":13827.8,"90th_percentile":13827.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15622.82,"10th_percentile":15622.82,"90th_percentile":15690.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21173.63,"10th_percentile":21173.63,"90th_percentile":21173.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14918.06,"10th_percentile":11682.25,"90th_percentile":16925.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16814.5,"10th_percentile":16814.5,"90th_percentile":16814.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13513.94,"10th_percentile":13513.94,"90th_percentile":13513.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":43410.53,"10th_percentile":43410.53,"90th_percentile":43410.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"1 through 10","median_amount":6416.0,"10th_percentile":6416.0,"90th_percentile":6416.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13882.83,"10th_percentile":13882.83,"90th_percentile":13882.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":22439.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14944.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17304.03},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18169.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8219.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17779.52},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12841.99},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22439.79},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27112.0,"10th_percentile":27112.0,"90th_percentile":27112.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8871.35,"10th_percentile":8278.92,"90th_percentile":8899.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9319.59,"10th_percentile":9319.59,"90th_percentile":9319.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":16695.67,"10th_percentile":16695.67,"90th_percentile":16695.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":1268.74,"10th_percentile":1268.74,"90th_percentile":1268.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"1 through 10","median_amount":10869.0,"10th_percentile":10869.0,"90th_percentile":39712.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":29608.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10626.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19719.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22832.08},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23974.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10845.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11064.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23459.47},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16944.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29608.54},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":21492.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7952.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7713.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14313.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7952.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16573.46},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17402.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7952.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7872.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17028.87},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12299.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":21492.39},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7952.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":15930.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5894.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5717.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10609.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5894.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12284.85},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12899.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5894.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5835.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5953.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12622.42},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9117.06},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15930.94},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5894.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":47752.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17668.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17138.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31803.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17668.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":36823.83},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38665.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17668.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17491.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17845.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37835.68},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":27328.38},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":47752.97},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17668.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16983.0,"10th_percentile":16983.0,"90th_percentile":16983.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15333.79,"10th_percentile":15333.79,"90th_percentile":15333.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":30434.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11260.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20269.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11260.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23469.16},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24642.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11260.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11148.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11373.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24114.06},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17417.37},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30434.7},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11260.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10979.87,"10th_percentile":10979.87,"90th_percentile":10979.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11322.0,"10th_percentile":11294.92,"90th_percentile":22204.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11668.08,"10th_percentile":10297.92,"90th_percentile":11715.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12654.26,"10th_percentile":12654.26,"90th_percentile":16704.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"1 through 10","median_amount":24817.75,"10th_percentile":24817.75,"90th_percentile":24817.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11203.94,"10th_percentile":11203.94,"90th_percentile":11203.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11675.85,"10th_percentile":11675.85,"90th_percentile":11675.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":17417.37,"10th_percentile":17417.37,"90th_percentile":17417.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7260.64,"10th_percentile":7260.64,"90th_percentile":7260.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":24313.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8726.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16192.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18749.15},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19686.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8906.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9086.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19264.35},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13914.47},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24313.82},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8996.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":16695.11,"10th_percentile":16695.11,"90th_percentile":16695.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8768.02,"10th_percentile":8768.02,"90th_percentile":8768.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":34830.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12887.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23197.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12887.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26858.92},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28202.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12887.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12758.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13016.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27596.95},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19933.03},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34830.52},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12887.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11919.44,"10th_percentile":11919.44,"90th_percentile":11919.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":13656.0,"10th_percentile":7954.0,"90th_percentile":59176.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11593.34,"10th_percentile":8402.36,"90th_percentile":12676.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13026.8,"10th_percentile":6778.54,"90th_percentile":13708.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":29108.2,"10th_percentile":29108.2,"90th_percentile":29108.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9037.65,"10th_percentile":4343.83,"90th_percentile":12907.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":10079.51,"10th_percentile":10079.51,"90th_percentile":10079.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":4037.0,"10th_percentile":4037.0,"90th_percentile":4037.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10821.58,"10th_percentile":9587.22,"90th_percentile":12556.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":17498.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6280.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11653.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13493.57},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14168.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6539.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13864.35},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10014.09},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17498.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2423.54,"10th_percentile":2423.54,"90th_percentile":2423.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":6772.0,"10th_percentile":2293.53,"90th_percentile":13026.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7040.24,"10th_percentile":5384.31,"90th_percentile":7045.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10308.77,"10th_percentile":10308.77,"90th_percentile":10308.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7461.18,"10th_percentile":5794.52,"90th_percentile":7608.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":13708.47,"10th_percentile":13708.47,"90th_percentile":13708.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"1 through 10","median_amount":11950.67,"10th_percentile":11950.67,"90th_percentile":11950.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6793.76,"10th_percentile":6793.76,"90th_percentile":6793.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7185.36,"10th_percentile":7185.36,"90th_percentile":7212.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":9075.43,"10th_percentile":9075.43,"90th_percentile":9075.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6510.88,"10th_percentile":6143.54,"90th_percentile":7296.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":11853.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4254.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7894.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9140.85},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9598.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4342.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4429.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9392.02},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6783.77},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11853.81},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4385.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":284.04,"10th_percentile":284.04,"90th_percentile":284.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5150.96,"10th_percentile":5150.96,"90th_percentile":5151.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":7364.83,"10th_percentile":7364.83,"90th_percentile":7364.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":26131.93,"10th_percentile":26131.93,"90th_percentile":26131.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":3822.43,"10th_percentile":3822.43,"90th_percentile":3822.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":25437.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9412.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9129.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16941.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9412.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19615.96},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20597.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9412.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9506.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20154.97},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14557.75},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25437.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9412.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":14971.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5539.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5373.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9970.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5539.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11544.93},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12122.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5539.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5594.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11862.16},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8567.93},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14971.41},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5539.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6259.37,"10th_percentile":6259.37,"90th_percentile":6259.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5563.53,"10th_percentile":5563.53,"90th_percentile":5563.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13835.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5119.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4965.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9214.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5119.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10668.77},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11202.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5119.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5067.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5170.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10961.93},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7917.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13835.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5119.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2500.24,"10th_percentile":2500.24,"90th_percentile":2500.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":2234.22,"10th_percentile":1470.98,"90th_percentile":4782.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5789.83,"10th_percentile":4925.72,"90th_percentile":5945.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4691.84,"10th_percentile":2571.6,"90th_percentile":6285.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6078.51,"10th_percentile":6078.51,"90th_percentile":6078.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5897.37,"10th_percentile":5897.37,"90th_percentile":5897.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":1982.65,"10th_percentile":1982.65,"90th_percentile":5966.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5956.93,"10th_percentile":2516.28,"90th_percentile":5972.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":28834.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10348.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19203.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22235.07},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23347.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22846.05},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16501.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28834.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62175.0,"10th_percentile":62175.0,"90th_percentile":62175.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9884.32,"10th_percentile":9884.32,"90th_percentile":11215.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11276.84,"10th_percentile":9934.24,"90th_percentile":12114.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11422.68,"10th_percentile":11422.68,"90th_percentile":11422.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":17770.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11835.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13703.26},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14388.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6509.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6640.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14079.8},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10169.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17770.32},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2341.95,"10th_percentile":2341.95,"90th_percentile":2341.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19984.0,"10th_percentile":19984.0,"90th_percentile":19984.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7282.72,"10th_percentile":7282.72,"90th_percentile":7282.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13097.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4846.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4700.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8722.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4846.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10099.81},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10604.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4846.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4797.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4894.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10377.33},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7495.45},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13097.38},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4846.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2090.76,"10th_percentile":2090.76,"90th_percentile":2090.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6962.54,"10th_percentile":6962.54,"90th_percentile":6962.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":27786.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10280.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9972.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10280.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21427.03},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22498.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10280.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10383.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22015.81},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15901.82},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27786.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10280.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10499.43,"10th_percentile":10499.43,"90th_percentile":10499.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7972.51,"10th_percentile":7972.51,"90th_percentile":7972.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":17853.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6605.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11890.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6605.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13767.36},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14455.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6605.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6539.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6671.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14145.67},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10217.29},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17853.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6605.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7432.45,"10th_percentile":7432.45,"90th_percentile":7432.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12556.0,"10th_percentile":12556.0,"90th_percentile":12556.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7187.3,"10th_percentile":7187.3,"90th_percentile":7187.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7791.99,"10th_percentile":7791.99,"90th_percentile":7791.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":33211.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11919.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22118.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25610.13},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26891.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12165.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12410.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26313.85},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19006.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33211.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":14292.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5288.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9518.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5288.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11021.37},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11572.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5288.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5235.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5341.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11324.22},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8179.38},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14292.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5288.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":3389.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10727.14,"10th_percentile":10727.14,"90th_percentile":10727.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10333.14,"10th_percentile":10333.14,"90th_percentile":10333.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":3389.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4801.84,"10th_percentile":4801.84,"90th_percentile":4801.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6930.56,"10th_percentile":6930.56,"90th_percentile":7060.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7157.98,"10th_percentile":7157.98,"90th_percentile":7157.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":3389.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":31349.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11599.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11251.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20878.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11599.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24174.36},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25383.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11599.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11483.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11715.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24838.63},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17940.72},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31349.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11599.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15511.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5739.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5567.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10330.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5739.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11961.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12559.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5739.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5681.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5796.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12290.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8877.19},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15511.79},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5739.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6016.31,"10th_percentile":6016.31,"90th_percentile":6016.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":39586.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14647.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14207.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26364.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14647.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":30526.47},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32053.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14647.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14500.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14793.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31365.29},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":22654.87},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":39586.59},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14647.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14235.98,"10th_percentile":14235.98,"90th_percentile":14235.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":24175.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8944.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16100.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8944.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18642.3},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19574.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8944.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8855.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9034.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19154.56},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13835.17},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24175.26},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8944.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9259.4,"10th_percentile":9259.4,"90th_percentile":9259.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":16554.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5941.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11025.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12765.66},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13404.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6063.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6186.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13116.44},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9473.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16554.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6035.64,"10th_percentile":6035.64,"90th_percentile":6035.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":39349.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14122.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26206.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":30343.5},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31861.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14413.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14704.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31177.28},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":22519.07},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":39349.31},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12700.46,"10th_percentile":12700.46,"90th_percentile":12700.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15095.06,"10th_percentile":15095.06,"90th_percentile":15095.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14523.59,"10th_percentile":14523.59,"90th_percentile":14523.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":22562.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8348.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15026.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8348.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17398.86},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18269.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8348.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8264.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8431.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17876.95},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12912.36},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22562.76},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8348.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6778.0,"10th_percentile":6778.0,"90th_percentile":6778.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2424.31,"10th_percentile":2424.31,"90th_percentile":2424.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6399.17,"10th_percentile":6399.17,"90th_percentile":6399.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15842.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5861.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5685.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10551.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5861.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12216.73},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12827.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5861.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5803.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5920.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12552.43},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9066.51},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15842.6},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5861.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6778.0,"10th_percentile":6778.0,"90th_percentile":6778.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6463.25,"10th_percentile":6463.25,"90th_percentile":6463.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":23413.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8662.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8402.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15593.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8662.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18054.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18957.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8662.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8576.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8749.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18550.75},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13399.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23413.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8662.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":19027.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7040.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12672.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7040.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14672.9},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15406.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7040.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6969.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7110.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15076.09},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10889.32},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19027.75},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7040.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1859.87,"10th_percentile":1859.87,"90th_percentile":1859.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5117.13,"maximum":14257.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5275.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5117.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9495.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5275.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10994.66},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11544.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5275.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5328.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11296.77},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8159.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14257.82},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5275.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":30417.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20257.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23455.81},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24628.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11141.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11366.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24100.33},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17407.45},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30417.38},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9868.95,"10th_percentile":9868.95,"90th_percentile":9868.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11688.54,"10th_percentile":11688.54,"90th_percentile":11688.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15475.05,"10th_percentile":15475.05,"90th_percentile":15475.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":12068.58,"10th_percentile":12068.58,"90th_percentile":12068.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":17718.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6359.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11800.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13663.19},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14346.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6490.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6621.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14038.63},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10139.98},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17718.36},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":3738.99,"10th_percentile":3738.99,"90th_percentile":3738.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7641.14,"10th_percentile":4840.0,"90th_percentile":9900.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7269.81,"10th_percentile":7110.61,"90th_percentile":8154.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7419.6,"10th_percentile":7419.6,"90th_percentile":7419.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":4385.87,"10th_percentile":4385.87,"90th_percentile":4385.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":3919.0,"10th_percentile":3919.0,"90th_percentile":3919.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13791.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5103.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4949.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9185.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5103.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10635.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11167.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5103.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5051.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5154.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10927.62},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7892.93},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13791.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5103.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2072.45,"10th_percentile":2072.45,"90th_percentile":2072.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1516.84,"10th_percentile":1516.84,"90th_percentile":1516.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4973.61,"10th_percentile":4973.61,"90th_percentile":4973.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6968.97,"10th_percentile":6968.97,"90th_percentile":6968.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5030.34,"10th_percentile":5030.34,"90th_percentile":5030.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":60956.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22553.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21877.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40596.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22553.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":47005.11},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49356.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22553.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22328.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22779.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48296.73},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":34884.29},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":60956.01},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22553.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":44671.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16032.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29751.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":34447.8},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36170.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16363.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16693.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35394.36},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":25565.03},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":44671.74},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14125.71,"10th_percentile":14125.71,"90th_percentile":14125.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":44671.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16032.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29751.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":34447.8},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36170.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16363.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16693.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35394.36},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":25565.03},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":44671.74},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":62556.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22451.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41662.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":48239.2},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50651.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22914.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23377.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49564.73},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35800.16},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":62556.38},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33966.0,"10th_percentile":33966.0,"90th_percentile":33966.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":39747.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14706.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14265.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26471.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14706.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":30650.68},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32183.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14706.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14853.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31492.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":22747.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":39747.67},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14706.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":23596.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8468.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15715.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18196.21},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19106.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8643.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8818.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18696.22},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13504.11},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23596.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":33545.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22341.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25867.9},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27161.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12535.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26578.71},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19197.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33545.38},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":24488.95,"10th_percentile":24488.95,"90th_percentile":24488.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22544.0,"10th_percentile":22544.0,"90th_percentile":22544.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10723.82,"10th_percentile":10723.82,"90th_percentile":10723.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13653.56,"10th_percentile":12454.04,"90th_percentile":13653.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10362.47,"10th_percentile":10362.47,"90th_percentile":10362.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":17837.62,"10th_percentile":17837.62,"90th_percentile":19197.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11681.29,"10th_percentile":11122.15,"90th_percentile":11930.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":15633.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5610.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10411.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12055.13},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12658.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5726.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5842.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12386.38},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8946.57},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15633.03},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5578.3,"10th_percentile":5578.3,"90th_percentile":5578.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":1681.41,"10th_percentile":1269.43,"90th_percentile":12956.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10292.86,"10th_percentile":10292.86,"90th_percentile":10292.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7056.73,"10th_percentile":7056.73,"90th_percentile":7056.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6146.34,"10th_percentile":6146.34,"90th_percentile":6146.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2196.02,"10th_percentile":2196.02,"90th_percentile":2196.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6264.91,"10th_percentile":6264.91,"90th_percentile":6264.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7924.86,"10th_percentile":7924.86,"90th_percentile":7924.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6680.14,"10th_percentile":6680.14,"90th_percentile":6680.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":19413.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7183.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6967.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12929.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7183.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14970.74},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15719.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7183.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7111.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7255.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15382.11},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11110.36},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19413.99},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7183.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":15911.82,"10th_percentile":15911.82,"90th_percentile":15911.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":14484.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5359.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5198.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9646.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5359.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11169.62},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11728.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5359.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5305.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5412.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11476.54},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8289.41},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14484.72},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5359.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":1883.83,"10th_percentile":1136.25,"90th_percentile":2358.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2645.07,"10th_percentile":2645.07,"90th_percentile":2645.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2266.95,"10th_percentile":2266.95,"90th_percentile":2266.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6235.95,"10th_percentile":6235.95,"90th_percentile":6235.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7095.97,"10th_percentile":7095.97,"90th_percentile":7095.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6262.29,"10th_percentile":6262.29,"90th_percentile":6262.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":40721.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14614.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27120.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":31401.29},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32971.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14916.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15217.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32264.15},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23304.1},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":40721.05},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":23433.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8410.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15606.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18070.67},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18974.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8583.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8757.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18567.22},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13410.94},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23433.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":26584.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9541.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17705.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20500.12},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21525.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9737.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9934.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21063.43},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15213.93},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26584.47},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":31316.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11587.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11239.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20856.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11587.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24148.98},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25356.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11587.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11471.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11702.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24812.56},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17921.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31316.29},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11587.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":18790.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6952.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6743.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12514.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6952.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14489.92},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15214.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6952.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14888.08},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10753.53},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18790.47},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6952.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":20148.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7454.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7231.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13418.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7454.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15537.03},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16314.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7454.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7529.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15963.97},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11530.63},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20148.36},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7454.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13610.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5035.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4884.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9064.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5035.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10495.14},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11020.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5035.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4985.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5086.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10783.53},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7788.85},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13610.06},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5035.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13831.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5117.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4964.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9211.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5117.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10666.1},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11199.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5117.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5066.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5168.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10959.19},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7915.72},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13831.75},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5117.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":22916.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8478.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8224.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15262.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8478.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17671.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18555.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8478.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8394.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18156.9},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13114.57},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22916.09},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8478.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8695.41,"10th_percentile":8695.41,"90th_percentile":8695.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13298.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4920.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4772.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8856.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4920.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10254.74},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10767.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4920.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4969.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10536.52},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7610.43},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13298.3},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4920.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2563.85,"10th_percentile":2563.85,"90th_percentile":2563.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":7623.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":7623.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":37584.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13489.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25031.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28982.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30432.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13767.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29778.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21509.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":37584.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6311.25,"maximum":17585.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6506.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6311.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11711.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6506.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13560.35},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14238.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6506.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6441.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6571.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13932.96},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10063.65},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17585.0},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6506.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":25862.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17224.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19943.18},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20940.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9473.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20491.18},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14800.6},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25862.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":15348.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10222.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11836.09},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12428.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5622.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5735.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12161.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8784.01},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15348.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":21402.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7918.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7681.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14253.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7918.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16504.01},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17329.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7918.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7839.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7998.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16957.51},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12248.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":21402.32},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7918.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":73875.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27333.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26513.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49200.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27333.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":56967.35},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59816.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27333.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27060.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27607.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58532.71},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":42277.65},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":73875.0},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27333.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":37776.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13977.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13558.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25159.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13977.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29130.77},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30587.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13977.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13837.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14117.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29931.24},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21619.06},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":37776.65},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13977.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9923.45,"maximum":27649.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9923.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18414.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21321.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22387.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10128.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10332.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21907.4},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15823.52},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27649.65},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10764.0,"10th_percentile":10764.0,"90th_percentile":10764.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":64891.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24009.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23289.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43217.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24009.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":50039.59},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52542.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24009.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23769.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24249.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51414.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":37136.3},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":64891.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24009.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10771.95,"maximum":30013.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19989.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23144.61},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24302.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11216.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23780.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17176.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30013.83},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7473.67,"maximum":20823.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7704.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7473.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13868.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7704.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16057.92},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16861.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7704.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7627.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7781.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16499.16},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11917.2},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20823.84},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7704.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":36673.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13569.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13162.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24424.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13569.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28279.99},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29694.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13569.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13433.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13704.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29057.08},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20987.67},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36673.37},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13569.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12464.64,"10th_percentile":12464.64,"90th_percentile":12464.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15581.58,"10th_percentile":15581.58,"90th_percentile":15581.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":22022.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8148.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7903.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14666.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8148.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16982.15},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17831.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8148.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8066.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8229.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17448.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12603.11},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22022.38},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8148.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":13805.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5108.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4954.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9194.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5108.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10646.07},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11178.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5108.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5057.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5159.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10938.6},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7900.86},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13805.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5108.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13017.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4816.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4672.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8669.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4816.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10038.37},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10540.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4816.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4768.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4864.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10314.21},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7449.86},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13017.71},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4816.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2411.8,"10th_percentile":2411.8,"90th_percentile":2411.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":4747.59,"10th_percentile":4747.59,"90th_percentile":4747.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2132.23,"10th_percentile":1377.99,"90th_percentile":3216.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2613.75,"10th_percentile":2613.75,"90th_percentile":2613.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2736.52,"10th_percentile":2736.52,"90th_percentile":2736.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7782.66,"10th_percentile":7782.66,"90th_percentile":7782.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":23061.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8532.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8276.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15358.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8532.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17783.51},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18672.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8532.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8447.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8618.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18272.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13197.83},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23061.58},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8532.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":12712.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4703.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4562.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8466.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4703.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9803.3},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10293.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4703.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4656.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4750.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10072.68},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7275.41},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12712.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4703.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":20475.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7576.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7348.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13636.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7576.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15789.46},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16579.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7576.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7500.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16223.33},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11717.97},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20475.7},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7576.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":12785.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4588.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8515.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9859.4},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10352.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4683.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4777.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10130.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7317.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12785.62},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13281.0,"10th_percentile":13281.0,"90th_percentile":13281.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":27079.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18035.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20882.11},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21926.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9919.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21455.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15497.41},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27079.82},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":15873.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5873.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10571.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5873.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12240.77},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12853.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5873.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5814.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12577.13},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9084.35},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15873.78},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5873.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":11969.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4428.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4295.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7971.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4428.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9230.33},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9691.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4428.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4384.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4473.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9483.97},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6850.18},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11969.85},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4428.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":29734.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11001.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10671.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19803.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11001.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22929.58},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24076.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11001.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10891.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11111.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23559.65},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17016.92},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29734.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11001.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":15757.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5830.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5655.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10494.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5830.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12151.29},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12759.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5830.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5772.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12485.19},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9017.94},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15757.74},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5830.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":12271.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4540.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4404.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8172.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4540.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9462.73},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9936.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4540.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4494.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4585.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9722.75},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7022.65},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12271.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4540.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":77624.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28721.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27859.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51698.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28721.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":59858.92},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62852.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28721.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28433.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29008.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61503.74},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":44423.6},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":77624.78},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28721.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":43715.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16174.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15689.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29114.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16174.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":33710.54},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35396.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16174.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16336.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34636.85},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":25017.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":43715.68},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16174.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":33153.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12266.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11898.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22080.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12266.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25566.06},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26844.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12266.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12144.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12389.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26268.57},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18973.55},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33153.94},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12266.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":64736.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23952.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23234.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43114.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23952.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":49920.72},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52417.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23952.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23713.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24192.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51292.46},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":37048.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":64736.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23952.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24091.96,"10th_percentile":24091.96,"90th_percentile":24091.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":31234.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11556.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20802.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11556.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24086.21},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25290.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11556.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11441.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11672.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24748.06},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17875.3},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31234.89},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11556.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3525.69,"10th_percentile":3525.69,"90th_percentile":3525.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":23666.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15761.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18249.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19162.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8843.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18751.11},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13543.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23666.05},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":51551.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19073.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18501.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34333.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19073.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":39752.8},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41741.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19073.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18883.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19264.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40845.14},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":29502.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":51551.25},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19073.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39627.0,"10th_percentile":39627.0,"90th_percentile":50199.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":23790.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8802.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8538.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15844.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8802.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18345.8},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19263.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8802.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8714.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8890.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18849.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13615.12},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23790.75},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8802.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13556.0,"10th_percentile":6578.0,"90th_percentile":16219.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9313.76,"10th_percentile":9313.76,"90th_percentile":9313.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8557.14,"10th_percentile":8557.14,"90th_percentile":8557.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9615.34,"10th_percentile":9615.34,"90th_percentile":9615.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13942.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5158.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5003.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9285.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5158.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10751.58},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11289.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5158.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5107.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5210.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11047.02},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7979.16},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13942.6},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5158.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4102.25,"10th_percentile":4102.25,"90th_percentile":4102.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2372.34,"10th_percentile":1675.94,"90th_percentile":15167.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5873.11,"10th_percentile":5873.11,"90th_percentile":5875.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7979.16,"10th_percentile":7979.16,"90th_percentile":7979.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5180.13,"10th_percentile":5180.13,"90th_percentile":5180.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":27065.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18025.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20871.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21915.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9914.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21444.93},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15489.48},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27065.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10014.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3700.0,"10th_percentile":2501.0,"90th_percentile":13770.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10500.63,"10th_percentile":9563.29,"90th_percentile":10700.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9089.85,"10th_percentile":7853.79,"90th_percentile":10763.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10810.96,"10th_percentile":10810.96,"90th_percentile":10810.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10702.62,"10th_percentile":10702.62,"90th_percentile":10702.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":15489.48,"10th_percentile":15489.48,"90th_percentile":15489.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9340.94,"10th_percentile":8605.73,"90th_percentile":10855.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":16904.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6066.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11258.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13035.46},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13687.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6192.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6317.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13393.65},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9674.11},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16904.32},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6897.09,"10th_percentile":6897.09,"90th_percentile":6897.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2511.18,"10th_percentile":2511.18,"90th_percentile":2511.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7136.17,"10th_percentile":7136.17,"90th_percentile":7136.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13076.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4838.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8709.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4838.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10083.78},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10588.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4838.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4789.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4886.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10360.87},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7483.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13076.6},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4838.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":30587.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10977.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20371.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23586.7},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24766.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11204.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11430.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24234.82},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17504.59},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30587.12},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1434.58,"10th_percentile":1434.58,"90th_percentile":1434.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":17324.19,"10th_percentile":17324.19,"90th_percentile":17324.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18549.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12354.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14304.28},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15019.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6794.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14697.33},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10615.75},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18549.72},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13055.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4830.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4685.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8695.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4830.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10067.75},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10571.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4830.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4782.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4878.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10344.4},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7471.67},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13055.82},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4830.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1374.34,"10th_percentile":1374.34,"90th_percentile":1374.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":26497.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9804.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9510.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17647.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9804.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20433.34},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21455.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9804.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9706.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9902.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20994.82},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15164.37},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26497.87},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9804.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18430.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6819.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6614.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12274.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6819.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14212.12},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14922.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6819.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6887.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14602.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10547.36},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18430.21},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6819.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":155.0,"10th_percentile":155.0,"90th_percentile":155.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13622.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5040.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4888.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9072.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5040.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10504.49},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11029.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5040.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4989.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10793.14},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7795.79},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13622.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5040.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":26993.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17977.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20815.33},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21856.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9887.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10087.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21387.3},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15447.85},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26993.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":15660.96,"10th_percentile":15660.96,"90th_percentile":15660.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10671.08,"10th_percentile":10671.08,"90th_percentile":10671.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":17131.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6338.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11409.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6338.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13210.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13871.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6338.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6275.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6401.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13573.42},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9803.96},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17131.21},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6338.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":12421.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4596.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4458.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8272.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4596.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9578.92},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10058.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4596.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4550.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4642.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9842.14},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7108.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12421.9},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4596.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1644.73,"10th_percentile":1644.73,"90th_percentile":1644.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":21397.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7916.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7916.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16500.0},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17325.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7916.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7837.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7996.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16953.39},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12245.28},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":21397.13},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7916.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8556.85,"10th_percentile":8018.09,"90th_percentile":8557.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2254.89,"10th_percentile":1727.41,"90th_percentile":10200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8323.57,"10th_percentile":6423.51,"90th_percentile":8469.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":8296.36,"10th_percentile":6985.7,"90th_percentile":8984.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5826.3,"10th_percentile":2407.12,"90th_percentile":8471.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":14980.84,"10th_percentile":14980.84,"90th_percentile":14980.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":12265.11,"10th_percentile":3718.49,"90th_percentile":12265.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7551.84,"10th_percentile":6351.88,"90th_percentile":8557.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":19185.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6885.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12777.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14794.44},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15534.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7027.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7169.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15200.97},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10979.52},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19185.36},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7098.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7876.69,"10th_percentile":7876.69,"90th_percentile":7876.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12750.0,"10th_percentile":12750.0,"90th_percentile":12750.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7669.39,"10th_percentile":7669.39,"90th_percentile":7669.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7876.93,"10th_percentile":7876.93,"90th_percentile":7876.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7386.33,"10th_percentile":7386.33,"90th_percentile":7386.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":15410.93,"10th_percentile":15410.93,"90th_percentile":15410.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":14600.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5402.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5240.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9724.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5402.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11259.11},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11822.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5402.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5348.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5456.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11568.49},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8355.82},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14600.76},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5402.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6118.49,"10th_percentile":6118.49,"90th_percentile":6118.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5666.55,"10th_percentile":5666.55,"90th_percentile":5666.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":11119.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4114.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3990.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7405.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4114.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8574.55},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9003.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4114.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4073.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4155.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8810.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6363.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11119.44},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4114.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":22765.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8423.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8170.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15161.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8423.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17555.13},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18433.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8423.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8507.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18037.51},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13028.33},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22765.41},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8423.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7417.26,"10th_percentile":7417.26,"90th_percentile":9034.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":23988.69,"10th_percentile":23988.69,"90th_percentile":23988.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":7503.0,"10th_percentile":1727.41,"90th_percentile":14978.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":8763.23,"10th_percentile":7626.65,"90th_percentile":8942.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16593.84,"10th_percentile":16593.84,"90th_percentile":16593.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8316.45,"10th_percentile":7305.47,"90th_percentile":9524.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9034.49,"10th_percentile":9034.49,"90th_percentile":9034.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8944.08,"10th_percentile":8471.28,"90th_percentile":9024.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":11081.34,"10th_percentile":11081.34,"90th_percentile":11829.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":22567.29,"10th_percentile":22567.29,"90th_percentile":22567.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":16148.0,"10th_percentile":16148.0,"90th_percentile":16148.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":9034.26,"10th_percentile":6004.64,"90th_percentile":9057.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13958.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5164.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5009.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9296.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5164.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10763.6},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11301.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5164.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5112.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5216.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11059.37},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7988.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13958.19},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5164.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12750.0,"10th_percentile":12750.0,"90th_percentile":12750.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5910.63,"10th_percentile":5910.63,"90th_percentile":5910.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5147.2,"10th_percentile":5147.2,"90th_percentile":5147.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":2758.11,"10th_percentile":2758.11,"90th_percentile":6456.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6112.56,"10th_percentile":6112.56,"90th_percentile":6112.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":10885.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4027.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3906.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7249.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4027.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8394.25},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8814.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4027.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3987.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4067.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8624.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6229.69},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":10885.62},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4027.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":12296.29,"10th_percentile":12296.29,"90th_percentile":12296.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1155.3,"10th_percentile":1155.3,"90th_percentile":1155.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8950.92,"10th_percentile":8950.92,"90th_percentile":8950.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":32686.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12093.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21769.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12093.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25205.44},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26466.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12093.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11972.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25898.05},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18705.93},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":32686.3},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12093.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":16438.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5899.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10947.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12676.18},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13310.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6021.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6143.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13024.5},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9407.48},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16438.41},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":12404.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4589.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4452.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8261.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4589.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9565.57},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10043.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4589.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4543.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4635.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9828.41},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7098.97},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12404.58},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4589.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":30554.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11305.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10965.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20349.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11305.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23561.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24739.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11305.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11418.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24208.74},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17485.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30554.21},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11305.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11723.13,"10th_percentile":11723.13,"90th_percentile":11723.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11385.14,"10th_percentile":11385.14,"90th_percentile":11385.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11710.63,"10th_percentile":11710.63,"90th_percentile":11710.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":19039.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7044.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12680.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7044.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14682.25},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15416.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7044.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6974.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7115.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15085.69},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10896.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19039.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7044.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38250.0,"10th_percentile":38250.0,"90th_percentile":38250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7605.43,"10th_percentile":7605.43,"90th_percentile":7605.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":12385.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4582.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4445.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8248.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4582.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9550.88},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10028.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4582.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4536.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4628.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9813.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7088.07},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12385.53},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4582.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4079.99,"10th_percentile":4079.99,"90th_percentile":4079.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":5159.68,"10th_percentile":5159.68,"90th_percentile":5159.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":16821.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6037.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11202.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12971.35},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13620.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6161.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6286.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13327.78},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9626.53},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16821.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6746.24,"10th_percentile":6746.24,"90th_percentile":6746.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7307.05,"10th_percentile":7307.05,"90th_percentile":7307.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":1686.0,"10th_percentile":1686.0,"90th_percentile":1686.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6973.47,"10th_percentile":6973.47,"90th_percentile":6973.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":11604.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4293.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4164.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7728.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4293.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8948.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9396.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4293.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4250.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4336.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9194.41},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6641.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11604.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4293.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1331.29,"10th_percentile":1331.29,"90th_percentile":1331.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13984.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5174.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5018.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9313.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5174.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10783.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11322.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5174.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5122.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5225.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11079.95},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8002.95},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13984.17},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5174.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":2308.66,"10th_percentile":2308.66,"90th_percentile":2308.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":31712.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21120.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24454.84},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25677.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11616.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25126.81},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18148.87},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31712.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6585.35,"10th_percentile":6585.35,"90th_percentile":6585.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":16299.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5850.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12569.33},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13197.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6091.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12914.72},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9328.18},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16299.85},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1151.78,"10th_percentile":1151.78,"90th_percentile":1151.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2236.5,"10th_percentile":2236.5,"90th_percentile":2236.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7369.21,"10th_percentile":7369.21,"90th_percentile":7369.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":111449.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41236.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39999.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74224.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41236.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":85941.85},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":90240.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41236.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40823.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41648.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88303.39},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":63780.75},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":111449.0},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41236.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":100144.0,"10th_percentile":100144.0,"90th_percentile":100144.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":58102.89,"10th_percentile":58102.89,"90th_percentile":58102.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":47607.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17614.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17086.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31706.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17614.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":36711.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38547.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17614.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17438.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17790.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37720.41},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":27245.11},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":47607.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17614.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22669.0,"10th_percentile":19710.04,"90th_percentile":60234.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16711.63,"10th_percentile":16711.63,"90th_percentile":16711.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18057.21,"10th_percentile":18057.21,"90th_percentile":18057.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":26601.83,"10th_percentile":26601.83,"90th_percentile":26601.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18039.2,"10th_percentile":18039.2,"90th_percentile":18039.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":188339.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69685.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67594.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":125433.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69685.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":145234.48},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":152498.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69685.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68988.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70382.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":149225.27},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":107784.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":188339.41},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69685.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":176620.0,"10th_percentile":176620.0,"90th_percentile":176620.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":101563.93,"10th_percentile":101563.93,"90th_percentile":101563.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":172455.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63808.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61894.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":114855.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63808.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":132985.69},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":139636.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63808.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63170.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64446.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":136639.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":98693.78},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":172455.24},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63808.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":169438.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62692.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60811.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":112845.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62692.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":130659.08},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":137193.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62692.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62065.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63318.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":134249.36},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":96967.11},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":169438.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62692.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":79340.5,"10th_percentile":79340.5,"90th_percentile":79340.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56181.85,"10th_percentile":56181.85,"90th_percentile":59583.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85800.68,"10th_percentile":85800.68,"90th_percentile":85800.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":113884.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42137.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40872.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75846.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42137.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":87819.71},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":92212.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42137.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41715.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42558.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90232.84},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":65174.37},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":113884.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42137.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":76230.0,"10th_percentile":76230.0,"90th_percentile":76230.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63235.88,"10th_percentile":63235.88,"90th_percentile":63235.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":113884.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42137.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40872.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75846.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42137.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":87819.71},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":92212.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42137.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41715.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42558.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90232.84},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":65174.37},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":113884.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42137.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":132988.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49205.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47729.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88569.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49205.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":102551.37},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":107680.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49205.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48713.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49697.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105369.31},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":76107.31},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":132988.16},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49205.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":127050.0,"10th_percentile":127050.0,"90th_percentile":165165.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44087.74,"10th_percentile":44087.74,"90th_percentile":44087.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95334.83,"10th_percentile":95334.83,"90th_percentile":95334.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":92364.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34174.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33149.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61514.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34174.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":71224.88},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74787.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34174.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33832.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34516.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73182.01},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":52858.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":92364.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34174.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32357.91,"10th_percentile":32357.91,"90th_percentile":32357.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32403.58,"10th_percentile":32403.58,"90th_percentile":32403.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":87296.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32299.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31330.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58139.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32299.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":67316.91},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":70683.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32299.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31976.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32622.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69166.66},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":49958.46},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":87296.26},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32299.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":85688.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31704.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30753.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57068.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31704.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":66077.47},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69382.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31704.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31387.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32021.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67893.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":49038.63},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":85688.97},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31704.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41403.62,"10th_percentile":41403.62,"90th_percentile":41403.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":54549.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19577.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36329.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":42064.72},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44168.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19981.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20385.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43220.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31217.84},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":54549.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20183.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5349.46,"10th_percentile":5349.46,"90th_percentile":5349.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19467.67,"10th_percentile":19467.67,"90th_percentile":19467.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":146005.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54022.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52401.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":97239.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54022.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":112589.74},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":118220.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54022.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53481.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54562.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115683.52},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":83557.17},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":146005.87},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54022.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":114345.0,"10th_percentile":114345.0,"90th_percentile":114345.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":105004.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38851.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37685.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38851.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":80972.09},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":85021.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38851.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38462.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39240.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83197.06},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":60092.49},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":105004.23},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38851.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":132414.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48993.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47523.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88188.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48993.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":102109.29},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":107216.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48993.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48503.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49483.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104915.08},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":75779.22},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":132414.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48993.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":60984.0,"10th_percentile":43114.65,"90th_percentile":68607.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46282.77,"10th_percentile":46282.77,"90th_percentile":128046.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30684.13,"10th_percentile":30684.13,"90th_percentile":30684.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":183579.83,"10th_percentile":183579.83,"90th_percentile":183579.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":114522.2,"10th_percentile":114522.2,"90th_percentile":134431.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":101184.55,"10th_percentile":68476.16,"90th_percentile":101575.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53359.4,"10th_percentile":53359.4,"90th_percentile":53359.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":94613.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35007.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33956.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63012.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35007.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":72959.82},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76608.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35007.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34657.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74964.63},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":54146.28},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":94613.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35007.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":68271.2,"10th_percentile":52561.0,"90th_percentile":98129.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31886.22,"10th_percentile":31886.22,"90th_percentile":31916.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59809.32,"10th_percentile":59809.32,"90th_percentile":59809.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43385.19,"10th_percentile":43385.19,"90th_percentile":43385.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":73009.1,"10th_percentile":73009.1,"90th_percentile":73074.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":52733.82,"10th_percentile":52733.82,"90th_percentile":52733.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":101644.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37608.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36480.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67694.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37608.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":78381.02},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":82301.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37608.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37232.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37984.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80534.8},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":58169.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":101644.15},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37608.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38115.0,"10th_percentile":38115.0,"90th_percentile":38115.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34721.42,"10th_percentile":34721.42,"90th_percentile":34721.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":69782.98,"10th_percentile":69782.98,"90th_percentile":69782.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":72550.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26843.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26038.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48318.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26843.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":55945.61},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58743.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26843.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26575.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27111.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57482.9},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":41519.39},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":72550.02},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26843.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":101441.08,"10th_percentile":101441.08,"90th_percentile":101441.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45889.9,"10th_percentile":37815.0,"90th_percentile":83853.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28502.98,"10th_percentile":28502.98,"90th_percentile":28502.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25311.08,"10th_percentile":25311.08,"90th_percentile":25311.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":56962.59,"10th_percentile":56962.59,"90th_percentile":56962.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22731.22,"10th_percentile":22731.22,"90th_percentile":22731.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24568.29,"10th_percentile":24568.29,"90th_percentile":24568.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":54154.81,"10th_percentile":54154.81,"90th_percentile":202524.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":46840.07,"10th_percentile":46840.07,"90th_percentile":46840.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":85243.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31540.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30593.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56772.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31540.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":65734.23},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69021.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31540.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31224.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31855.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67540.49},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":48783.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":85243.84},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31540.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26361.29,"10th_percentile":26361.29,"90th_percentile":26361.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":49925.75,"10th_percentile":49925.75,"90th_percentile":49925.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":49370.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18267.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17719.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32880.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18267.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":38071.28},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39975.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18267.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18084.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18449.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39117.41},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":28254.16},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":49370.66},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18267.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63728.0,"10th_percentile":63728.0,"90th_percentile":63728.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17810.66,"10th_percentile":17810.66,"90th_percentile":17810.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17241.97,"10th_percentile":17241.97,"90th_percentile":17241.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18328.99,"10th_percentile":18328.99,"90th_percentile":18328.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":28865.73,"10th_percentile":28865.73,"90th_percentile":28865.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":23977.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8605.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15969.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18490.05},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19414.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8783.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8960.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18998.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13722.17},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23977.81},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":55299.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19846.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36829.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":42643.04},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44775.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20256.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20665.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43814.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31647.03},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":55299.3},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23263.61,"10th_percentile":23263.61,"90th_percentile":23263.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20743.63,"10th_percentile":20743.63,"90th_percentile":20743.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22435.05,"10th_percentile":22435.05,"90th_percentile":22435.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47597.91,"10th_percentile":47597.91,"90th_percentile":47597.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":36907.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13245.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24580.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28460.3},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29883.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13519.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13792.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29242.34},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21121.48},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36907.19},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14618.78,"10th_percentile":14618.78,"90th_percentile":14943.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25185.0,"10th_percentile":25185.0,"90th_percentile":25185.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14167.82,"10th_percentile":14167.82,"90th_percentile":14167.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14884.05,"10th_percentile":14884.05,"90th_percentile":14884.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14461.05,"10th_percentile":14461.05,"90th_percentile":14461.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11235.67,"maximum":31305.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11583.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11235.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11583.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24140.97},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25348.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11583.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11467.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11699.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24804.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17915.94},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31305.9},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11583.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25185.0,"10th_percentile":25185.0,"90th_percentile":25185.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11583.59,"10th_percentile":11583.59,"90th_percentile":11600.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":79020.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29237.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28360.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52627.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29237.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":60935.41},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63983.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29237.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28945.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29530.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62609.82},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":45222.51},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":79020.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29237.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28454.14,"10th_percentile":28454.14,"90th_percentile":28454.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":7623.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":37800.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13566.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25175.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29149.47},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30607.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13846.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14126.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29950.45},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21632.94},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":37800.9},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14950.0,"10th_percentile":14950.0,"90th_percentile":14950.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27458.41,"10th_percentile":27458.41,"90th_percentile":27458.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15254.37,"10th_percentile":15254.37,"90th_percentile":15254.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":22922.49,"10th_percentile":22922.49,"90th_percentile":22922.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9290.02,"maximum":25884.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9290.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17239.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19960.54},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20958.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9481.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9673.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20509.02},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14813.48},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25884.74},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49620.0,"10th_percentile":49620.0,"90th_percentile":49620.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9323.14,"10th_percentile":9323.14,"90th_percentile":9323.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10714.9,"10th_percentile":10714.9,"90th_percentile":10714.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":60417.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22354.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21683.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40237.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22354.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":46589.73},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48919.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22354.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22130.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22577.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47869.94},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":34576.03},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":60417.36},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22354.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44408.0,"10th_percentile":44408.0,"90th_percentile":44408.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20958.99,"10th_percentile":20958.99,"90th_percentile":20988.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21406.38,"10th_percentile":21406.38,"90th_percentile":22515.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21592.23,"10th_percentile":21592.23,"90th_percentile":21592.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19066.27,"10th_percentile":19066.27,"90th_percentile":21787.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21595.43,"10th_percentile":20685.09,"90th_percentile":21723.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":44955.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16134.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29940.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":34666.83},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36400.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16467.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35619.42},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":25727.59},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":44955.79},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16633.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16412.98,"10th_percentile":16384.82,"90th_percentile":16413.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15046.0,"10th_percentile":15046.0,"90th_percentile":60984.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15965.47,"10th_percentile":15965.47,"90th_percentile":15965.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16325.27,"10th_percentile":16325.27,"90th_percentile":16893.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15636.55,"10th_percentile":15456.26,"90th_percentile":16220.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":30244.85,"10th_percentile":30244.85,"90th_percentile":30244.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14373.76,"10th_percentile":14373.76,"90th_percentile":14373.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":30859.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11075.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20552.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23796.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24986.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11303.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11532.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24450.27},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17660.21},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30859.04},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15146.0,"10th_percentile":15146.0,"90th_percentile":15146.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11168.86,"10th_percentile":11168.86,"90th_percentile":11168.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11808.71,"10th_percentile":11808.71,"90th_percentile":11808.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":17340.05,"10th_percentile":17340.05,"90th_percentile":17340.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":46718.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17285.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16767.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31114.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17285.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":36026.47},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37828.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17285.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17113.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17458.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37016.42},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":26736.63},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":46718.97},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17285.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":29407.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10554.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19585.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22677.15},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23811.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10989.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23300.28},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16829.58},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29407.63},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":30681.78,"10th_percentile":30681.78,"90th_percentile":30681.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18916.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6789.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12598.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14587.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15317.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7069.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14988.26},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10825.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18916.9},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":54421.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20135.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19531.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36244.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20135.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":41965.89},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44064.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20135.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19934.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20337.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43119.04},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31144.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":54421.17},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20135.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":35022.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12569.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23325.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27007.17},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28357.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12828.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13087.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27749.28},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20043.06},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":35022.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":56338.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20845.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37521.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20845.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":43444.4},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45617.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20845.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20636.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21053.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44638.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":32241.75},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":56338.5},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20845.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":32743.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11751.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21807.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25249.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26512.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11993.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12236.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25943.33},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18738.64},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":32743.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12115.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12494.6,"10th_percentile":12494.6,"90th_percentile":12494.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12736.95,"10th_percentile":12736.95,"90th_percentile":12736.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":28229.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10131.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18801.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21768.94},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22857.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10340.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22367.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16155.57},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28229.87},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7326.08,"10th_percentile":7326.08,"90th_percentile":7326.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":52954.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19593.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19005.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35267.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19593.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":40834.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42876.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19593.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19397.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19788.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41956.7},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":30304.95},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":52954.17},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19593.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14990.43,"10th_percentile":14990.43,"90th_percentile":14990.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":57859.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21407.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20765.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38534.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21407.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":44617.05},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46848.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21407.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21193.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21621.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45843.05},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":33112.03},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":57859.19},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21407.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19598.68,"10th_percentile":19598.68,"90th_percentile":19598.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26412.0,"10th_percentile":9810.71,"90th_percentile":82225.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6329.39,"10th_percentile":6329.39,"90th_percentile":6329.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":131201.43,"10th_percentile":131201.43,"90th_percentile":131201.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":62667.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23186.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22491.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41736.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23186.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":48324.68},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50741.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23186.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22954.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23418.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49652.56},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35863.6},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":62667.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23186.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":106143.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39273.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38094.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70691.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39273.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":81850.91},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":85944.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39273.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38880.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39665.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84100.03},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":60744.7},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":106143.89},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39273.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36608.24,"10th_percentile":36608.24,"90th_percentile":36608.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25410.0,"10th_percentile":25410.0,"90th_percentile":113945.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35718.77,"10th_percentile":31731.83,"90th_percentile":36441.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38665.29,"10th_percentile":36818.26,"90th_percentile":40602.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30118.0,"10th_percentile":30118.0,"90th_percentile":36818.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":82457.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30509.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29593.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54916.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30509.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":63585.24},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66765.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30509.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30203.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30814.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65332.46},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":47189.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":82457.06},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30509.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28302.07,"10th_percentile":28302.07,"90th_percentile":28302.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30483.37,"10th_percentile":30483.37,"90th_percentile":30483.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28885.96,"10th_percentile":28885.96,"90th_percentile":28885.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":119125.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44076.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42753.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79337.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44076.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":91861.23},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96455.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44076.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43635.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44517.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94385.42},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":68173.74},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":119125.23},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44076.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42883.38,"10th_percentile":42883.38,"90th_percentile":42883.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":14372.88,"10th_percentile":14372.88,"90th_percentile":14372.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":73145.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27063.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26252.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48715.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27063.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":56405.06},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59226.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27063.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26793.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27334.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57954.97},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":41860.36},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":73145.82},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27063.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":101590.0,"10th_percentile":101590.0,"90th_percentile":101590.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25672.48,"10th_percentile":25672.48,"90th_percentile":25672.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27242.65,"10th_percentile":27242.65,"90th_percentile":27242.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25707.04,"10th_percentile":25707.04,"90th_percentile":25707.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":39850.93,"10th_percentile":39850.93,"90th_percentile":39850.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":91385.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32798.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60862.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":70470.26},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73994.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33812.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33474.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34150.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72406.66},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":52298.69},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":91385.52},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33812.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":121668.0,"10th_percentile":121668.0,"90th_percentile":121668.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31184.95,"10th_percentile":31184.95,"90th_percentile":31184.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":251612.67,"10th_percentile":251612.67,"90th_percentile":251612.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":67867.76,"10th_percentile":67867.76,"90th_percentile":67867.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31679.97,"10th_percentile":31679.97,"90th_percentile":31679.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":61595.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22790.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22106.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41022.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22790.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":47497.94},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49873.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22790.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22562.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23018.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48803.1},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35250.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":61595.12},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22790.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21717.86,"10th_percentile":21717.86,"90th_percentile":21717.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22425.0,"10th_percentile":19638.22,"90th_percentile":106422.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":32756.89,"10th_percentile":32756.89,"90th_percentile":34140.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21105.75,"10th_percentile":21105.75,"90th_percentile":21105.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":44217.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16360.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15869.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29449.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16360.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":34097.87},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35803.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16360.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16197.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16524.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35034.82},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":25305.34},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":44217.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16360.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37877.5,"10th_percentile":37877.5,"90th_percentile":37877.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15600.04,"10th_percentile":15600.04,"90th_percentile":15600.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15414.14,"10th_percentile":15414.14,"90th_percentile":15414.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":71453.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26437.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25644.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47588.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26437.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":55100.18},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57856.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26437.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26173.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26702.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56614.24},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":40891.96},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":71453.66},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26437.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45438.0,"10th_percentile":45438.0,"90th_percentile":45438.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":57012.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21094.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20461.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37970.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21094.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":43963.95},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46162.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21094.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20883.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21305.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45172.0},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":32627.33},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":57012.24},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21094.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19486.42,"10th_percentile":19486.42,"90th_percentile":19486.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12458.0,"10th_percentile":12458.0,"90th_percentile":12458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19168.65,"10th_percentile":19162.85,"90th_percentile":20555.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20596.29,"10th_percentile":20517.84,"90th_percentile":20749.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19392.16,"10th_percentile":19392.16,"90th_percentile":19392.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":70507.81,"10th_percentile":70507.81,"90th_percentile":70507.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39151.88,"10th_percentile":39151.88,"90th_percentile":39151.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":123498.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45694.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44323.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82249.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45694.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":95233.62},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":99996.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45694.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45237.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46151.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97850.48},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":70676.52},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":123498.53},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45694.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":99664.0,"10th_percentile":99664.0,"90th_percentile":99664.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41917.32,"10th_percentile":41917.32,"90th_percentile":41917.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":104034.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38492.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37337.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69286.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38492.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":80224.15},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84236.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38492.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38107.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38877.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82428.57},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":59537.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":104034.31},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38492.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35459.0,"10th_percentile":35459.0,"90th_percentile":35459.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62275.0,"10th_percentile":62275.0,"90th_percentile":76230.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36887.13,"10th_percentile":36887.13,"90th_percentile":36887.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":79992.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29597.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28709.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53274.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29597.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":61684.69},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64769.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29597.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29301.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29893.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63379.68},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":45778.57},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":79992.42},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29597.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51115.76,"10th_percentile":51115.76,"90th_percentile":51115.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28669.27,"10th_percentile":28669.27,"90th_percentile":28669.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":96406.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35670.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34600.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64206.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35670.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":74342.17},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78060.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35670.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35313.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36027.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76384.96},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":55172.17},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":96406.58},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35670.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":112770.54,"10th_percentile":112770.54,"90th_percentile":112770.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":62462.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23111.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22417.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41600.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23111.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":48167.08},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50576.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23111.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22880.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23342.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49490.63},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35746.64},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":62462.85},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23111.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":27783.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9971.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18503.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21424.36},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22495.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10382.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22013.06},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15899.84},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27783.01},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10279.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10737.36,"10th_percentile":8988.97,"90th_percentile":11002.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"31","median_amount":10167.0,"10th_percentile":3239.0,"90th_percentile":20232.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":10611.49,"10th_percentile":9493.41,"90th_percentile":10847.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20128.36,"10th_percentile":20128.36,"90th_percentile":20128.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"30","median_amount":11237.21,"10th_percentile":9787.27,"90th_percentile":11528.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11182.42,"10th_percentile":8340.66,"90th_percentile":11384.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":10437.78,"10th_percentile":8262.1,"90th_percentile":10892.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11182.42,"10th_percentile":11182.42,"90th_percentile":11182.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":22524.93,"10th_percentile":22524.93,"90th_percentile":22524.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"21","median_amount":15196.73,"10th_percentile":9899.84,"90th_percentile":16269.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"1 through 10","median_amount":10992.28,"10th_percentile":10992.28,"90th_percentile":10992.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":12425.0,"10th_percentile":12425.0,"90th_percentile":16750.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":10574.0,"10th_percentile":6956.1,"90th_percentile":10981.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":15918.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5889.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10601.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5889.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12275.5},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12889.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5889.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5831.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5948.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12612.81},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9110.12},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15918.81},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5889.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6449.03,"10th_percentile":2341.95,"90th_percentile":6720.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":4463.0,"10th_percentile":3641.6,"90th_percentile":17758.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6480.19,"10th_percentile":2259.78,"90th_percentile":6612.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7014.64,"10th_percentile":2472.83,"90th_percentile":7032.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":12505.53,"10th_percentile":12505.53,"90th_percentile":12505.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6613.8,"10th_percentile":6469.19,"90th_percentile":6618.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":12649.86,"10th_percentile":12649.86,"90th_percentile":12812.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7456.55,"10th_percentile":7456.55,"90th_percentile":7456.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6112.31,"10th_percentile":6065.51,"90th_percentile":6270.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4494.89,"maximum":12524.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4633.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4494.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8341.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4633.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9657.72},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10140.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4633.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4587.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4680.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9923.1},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7167.37},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12524.09},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4633.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4213.0,"10th_percentile":1136.56,"90th_percentile":18208.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5357.54,"10th_percentile":5357.3,"90th_percentile":5641.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2781.55,"10th_percentile":2781.55,"90th_percentile":5786.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":9950.55,"10th_percentile":9950.55,"90th_percentile":9950.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":34307.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22848.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26455.56},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27778.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12820.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27182.52},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19633.69},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34307.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12693.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16383.0,"10th_percentile":16383.0,"90th_percentile":16383.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12825.6,"10th_percentile":12825.6,"90th_percentile":12825.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4302.81,"maximum":11988.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4435.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4302.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7984.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4435.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9245.02},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9707.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4435.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4391.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4480.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9499.06},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6861.09},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11988.9},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4435.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3722.85,"maximum":10372.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3837.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3722.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6908.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3837.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":7998.91},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8398.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3837.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3799.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3876.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8218.7},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":5936.3},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":10372.95},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3837.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4211.57,"10th_percentile":4211.57,"90th_percentile":4211.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":38325.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14180.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13755.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25524.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14180.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29554.16},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31032.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14180.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14038.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30366.25},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21933.27},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":38325.7},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14180.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12496.91,"10th_percentile":12496.91,"90th_percentile":12496.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":15708.94,"10th_percentile":4463.0,"90th_percentile":36416.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13968.74,"10th_percentile":13945.77,"90th_percentile":14212.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14704.37,"10th_percentile":14477.38,"90th_percentile":15119.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14947.67,"10th_percentile":14947.67,"90th_percentile":14947.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14233.3,"10th_percentile":14233.3,"90th_percentile":14233.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":3748.0,"10th_percentile":3748.0,"90th_percentile":3748.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":18101.02,"10th_percentile":18101.02,"90th_percentile":18101.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14358.91,"10th_percentile":14358.91,"90th_percentile":14396.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":18534.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6857.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6651.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12343.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6857.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14292.26},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15007.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6857.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6789.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6926.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14684.98},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10606.83},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18534.13},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6857.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2588.56,"10th_percentile":2588.56,"90th_percentile":2588.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":21425.85,"10th_percentile":21425.85,"90th_percentile":21425.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"28","median_amount":4596.87,"10th_percentile":3783.92,"90th_percentile":21125.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":7113.77,"10th_percentile":2850.84,"90th_percentile":7471.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4497.43,"10th_percentile":4497.43,"90th_percentile":4497.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7190.46,"10th_percentile":2878.47,"90th_percentile":8075.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":3021.98,"10th_percentile":3021.98,"90th_percentile":3021.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7678.86,"10th_percentile":7678.86,"90th_percentile":7835.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7645.64,"10th_percentile":7614.94,"90th_percentile":7645.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":3659.2,"10th_percentile":3659.2,"90th_percentile":14953.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":4984.13,"10th_percentile":4984.13,"90th_percentile":9982.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7684.78,"10th_percentile":7684.46,"90th_percentile":7701.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":46871.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17342.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16822.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31216.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17342.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":36144.01},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37951.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17342.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17168.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17515.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37137.18},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":26823.85},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":46871.38},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17342.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":29563.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10938.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10610.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19689.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10938.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22797.36},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23937.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10938.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10829.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11047.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23423.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16918.79},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29563.51},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10938.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15195.0,"10th_percentile":15195.0,"90th_percentile":15195.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":16102.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5957.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5779.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10724.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5957.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12417.07},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13038.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5957.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5898.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6017.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12758.27},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9215.19},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16102.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5957.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":22235.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8227.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7980.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14808.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8227.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17146.43},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18004.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8227.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8144.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8309.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17617.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12725.03},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22235.42},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8227.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7251.62,"10th_percentile":6351.0,"90th_percentile":8974.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":19846.24,"10th_percentile":19846.24,"90th_percentile":22295.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":10167.0,"10th_percentile":1877.24,"90th_percentile":27112.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":8404.63,"10th_percentile":6699.59,"90th_percentile":8866.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":9097.28,"10th_percentile":7225.12,"90th_percentile":9448.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9140.37,"10th_percentile":8957.56,"90th_percentile":9140.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":8745.49,"10th_percentile":6107.49,"90th_percentile":8897.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":16305.77,"10th_percentile":16305.77,"90th_percentile":16305.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":12933.18,"10th_percentile":12933.18,"90th_percentile":12933.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":8223.46,"10th_percentile":7855.08,"90th_percentile":8957.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":14704.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5277.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9793.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11339.24},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11906.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5386.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5495.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11650.83},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8415.29},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14704.68},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6910.96,"10th_percentile":6910.96,"90th_percentile":6910.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4850.17,"10th_percentile":4850.17,"90th_percentile":4850.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":9803.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3627.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3518.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6528.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3627.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":7559.5},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7937.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3627.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3590.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7767.22},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":5610.19},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":9803.12},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3627.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":2550.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":2550.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":27052.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9708.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18016.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20860.74},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21904.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9909.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10109.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21433.95},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15481.55},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27052.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3941.03,"maximum":10980.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3941.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7313.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8467.7},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8891.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4062.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4022.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4103.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8700.38},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6284.21},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":10980.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4062.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2828.97,"maximum":7882.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2916.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2828.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5249.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2916.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":6078.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6382.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2916.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2887.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2945.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6245.34},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":4510.95},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":7882.33},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2916.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":28278.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10149.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18833.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21806.34},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22896.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10358.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10567.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22405.54},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16183.32},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28278.36},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8504.68,"10th_percentile":8504.68,"90th_percentile":8504.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6778.0,"10th_percentile":6778.0,"90th_percentile":23423.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":3787.3,"10th_percentile":3787.3,"90th_percentile":3787.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":3279.09,"10th_percentile":3279.09,"90th_percentile":3279.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18489.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6840.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12313.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6840.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14257.53},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14970.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6840.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6772.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6909.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14649.3},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10581.06},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18489.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6840.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1155.01,"10th_percentile":1155.01,"90th_percentile":1155.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6813.73,"10th_percentile":6813.73,"90th_percentile":6813.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7561.22,"10th_percentile":7561.22,"90th_percentile":7561.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6043.69,"10th_percentile":6043.69,"90th_percentile":6043.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":12465.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4473.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8301.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9612.31},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10093.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4566.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4658.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9876.44},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7133.67},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12465.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4612.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1060.68,"10th_percentile":1060.68,"90th_percentile":1060.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":20725.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7438.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13802.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15981.79},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16781.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7591.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7744.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16420.94},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11860.7},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20725.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7668.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2355.07,"10th_percentile":2355.07,"90th_percentile":2355.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2967.14,"10th_percentile":2967.14,"90th_percentile":2967.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2475.33,"10th_percentile":2475.33,"90th_percentile":2475.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":11659.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4314.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4184.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7765.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4314.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8991.26},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9440.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4314.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4270.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4357.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9238.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6672.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11659.82},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4314.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2294.37,"10th_percentile":2204.31,"90th_percentile":9850.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4473.62,"10th_percentile":4473.62,"90th_percentile":4473.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":3932.0,"10th_percentile":3932.0,"90th_percentile":3932.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":20610.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7625.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7397.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13726.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7625.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15893.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16688.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7625.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7702.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16330.37},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11795.28},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20610.8},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7625.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":915.75,"10th_percentile":915.75,"90th_percentile":915.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6525.28,"10th_percentile":6525.28,"90th_percentile":6525.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":3400.14,"10th_percentile":3400.14,"90th_percentile":3400.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8184.91,"10th_percentile":8184.91,"90th_percentile":8184.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13078.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4838.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8710.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4838.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10085.12},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10589.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4838.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4790.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4887.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10362.24},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7484.55},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13078.33},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4838.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2356.37,"10th_percentile":2356.37,"90th_percentile":2356.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1617.03,"10th_percentile":778.05,"90th_percentile":9925.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4978.85,"10th_percentile":4790.84,"90th_percentile":5504.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":890.0,"10th_percentile":570.0,"90th_percentile":5946.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3582.7,"10th_percentile":2335.64,"90th_percentile":5293.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":1251.96,"10th_percentile":1251.96,"90th_percentile":1251.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":4440.94,"10th_percentile":4440.94,"90th_percentile":4440.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4978.05,"10th_percentile":4978.05,"90th_percentile":8072.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":27292.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9795.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18177.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21046.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22099.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9997.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21624.7},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15619.33},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27292.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":15816.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5852.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5676.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10533.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5852.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12196.7},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12806.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5852.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5793.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5910.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12531.84},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9051.64},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15816.62},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5852.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2098.99,"10th_percentile":2098.99,"90th_percentile":2098.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":20853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13888.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16080.62},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16884.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7792.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16522.49},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11934.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20853.28},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7715.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6136.22,"10th_percentile":3189.0,"90th_percentile":8532.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8130.22,"10th_percentile":8124.5,"90th_percentile":8284.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7888.57,"10th_percentile":7888.57,"90th_percentile":7888.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7265.37,"10th_percentile":7265.37,"90th_percentile":7265.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8324.72,"10th_percentile":8324.72,"90th_percentile":8324.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":16548.57,"10th_percentile":16548.57,"90th_percentile":16548.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":5384.56,"10th_percentile":5384.56,"90th_percentile":5384.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8369.22,"10th_percentile":4541.49,"90th_percentile":8369.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":12742.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4714.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4573.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8486.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4714.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9826.01},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10317.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4714.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4667.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4761.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10096.01},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7292.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12742.32},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4714.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":2341.63,"10th_percentile":1066.82,"90th_percentile":11866.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":4859.29,"10th_percentile":2305.9,"90th_percentile":6315.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2461.55,"10th_percentile":2361.5,"90th_percentile":5875.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":10102.22,"10th_percentile":10102.22,"90th_percentile":10102.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5605.27,"10th_percentile":5605.27,"90th_percentile":5605.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2321.3,"10th_percentile":2321.3,"90th_percentile":5551.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":405.0,"10th_percentile":405.0,"90th_percentile":405.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6314.6,"10th_percentile":6314.6,"90th_percentile":6314.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"1 through 10","median_amount":11169.0,"10th_percentile":11169.0,"90th_percentile":11169.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":398.46,"10th_percentile":398.46,"90th_percentile":398.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":9804.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3627.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3518.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6530.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3627.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":7560.83},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7938.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3627.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3591.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3664.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7768.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":5611.18},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":9804.85},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3627.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":3139.0,"10th_percentile":852.34,"90th_percentile":6182.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4396.72,"10th_percentile":4396.55,"90th_percentile":4402.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3008.4,"10th_percentile":3008.4,"90th_percentile":3008.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":5306.81,"10th_percentile":5306.81,"90th_percentile":5306.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":983.14,"10th_percentile":983.14,"90th_percentile":983.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":5545.76,"10th_percentile":5545.76,"90th_percentile":5545.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7678.02,"10th_percentile":7678.02,"90th_percentile":7678.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2349.45,"10th_percentile":2349.45,"90th_percentile":2349.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":12156.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4498.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4363.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8096.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4498.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9374.58},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9843.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4498.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4453.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4543.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9632.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6957.23},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12156.91},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4498.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2394.31,"10th_percentile":2394.31,"90th_percentile":2770.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15096.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5585.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5417.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10053.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5585.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11641.09},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12223.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5585.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5529.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5641.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11960.97},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8639.3},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15096.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5585.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5483.53,"10th_percentile":5483.53,"90th_percentile":5483.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2188.56,"10th_percentile":1123.09,"90th_percentile":15445.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6206.01,"10th_percentile":2280.68,"90th_percentile":6315.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6111.25,"10th_percentile":6111.25,"90th_percentile":6111.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2267.89,"10th_percentile":2267.89,"90th_percentile":6316.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":21550.72,"10th_percentile":21550.72,"90th_percentile":21550.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6395.24,"10th_percentile":6165.48,"90th_percentile":6395.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4475.62,"maximum":12470.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4614.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4475.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8305.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4614.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9616.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10097.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4614.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4567.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4660.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9880.56},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7136.64},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12470.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4614.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2159.34,"10th_percentile":1555.58,"90th_percentile":6821.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4709.83,"10th_percentile":4709.83,"90th_percentile":4994.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":125.0,"10th_percentile":125.0,"90th_percentile":125.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":2987.48,"10th_percentile":2987.48,"90th_percentile":2987.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2210.72,"10th_percentile":2210.72,"90th_percentile":2210.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2344.51,"10th_percentile":2344.51,"90th_percentile":5387.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":2949.0,"10th_percentile":2949.0,"90th_percentile":2949.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4497.05,"10th_percentile":4497.05,"90th_percentile":4497.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":36115.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13362.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12961.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24053.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13362.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27849.93},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29242.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13362.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13229.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13496.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28615.2},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20668.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36115.66},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13362.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12489.72,"10th_percentile":12489.72,"90th_percentile":12925.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20034.0,"10th_percentile":16945.0,"90th_percentile":37279.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6731.15,"10th_percentile":6731.15,"90th_percentile":6731.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14703.84,"10th_percentile":14703.84,"90th_percentile":14703.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":21345.49,"10th_percentile":21345.49,"90th_percentile":21345.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":16684.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6173.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5988.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11111.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6173.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12865.83},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13509.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6173.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6234.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13219.37},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9548.23},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16684.36},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6173.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6944.01,"10th_percentile":6944.01,"90th_percentile":6944.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1101.33,"10th_percentile":1101.33,"90th_percentile":1101.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7267.35,"10th_percentile":7267.35,"90th_percentile":7267.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6261.4,"10th_percentile":6261.4,"90th_percentile":6261.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":11813.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4371.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4240.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7868.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4371.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9110.13},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9565.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4371.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4327.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4414.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9360.46},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6760.98},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11813.97},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4371.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":115810.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41564.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77129.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":89304.89},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":93771.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42421.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43278.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91758.84},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":66276.59},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":115810.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42849.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39597.92,"10th_percentile":39597.92,"90th_percentile":39597.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":77297.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28600.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27742.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51480.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28600.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":59606.49},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62587.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28600.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28314.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28886.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61244.38},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":44236.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":77297.43},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28600.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24508.45,"10th_percentile":24508.45,"90th_percentile":24508.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":41659.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15414.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14951.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27745.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15414.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":32125.19},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33731.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15414.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15259.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15568.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33007.93},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23841.33},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":41659.8},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15414.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":47124.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16912.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31384.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":36339.0},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38156.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17261.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37337.54},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":26968.57},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":47124.26},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17435.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18158.53,"10th_percentile":18158.53,"90th_percentile":18158.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":25410.0,"10th_percentile":12705.0,"90th_percentile":50820.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17940.58,"10th_percentile":17587.57,"90th_percentile":44193.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25480.86,"10th_percentile":25480.86,"90th_percentile":25480.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19049.92,"10th_percentile":18629.36,"90th_percentile":66304.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17689.43,"10th_percentile":17689.43,"90th_percentile":17689.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18309.52,"10th_percentile":18309.52,"90th_percentile":18310.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":70846.05,"10th_percentile":70846.05,"90th_percentile":70846.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":39142.37,"10th_percentile":39142.37,"90th_percentile":39142.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":109331.55,"10th_percentile":109331.55,"90th_percentile":109331.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15920.27,"10th_percentile":11964.13,"90th_percentile":18125.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10959.05,"maximum":30535.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10959.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20336.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23546.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24724.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11185.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24193.65},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17474.86},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30535.16},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11711.63,"10th_percentile":11711.63,"90th_percentile":11961.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":68864.8,"10th_percentile":68864.8,"90th_percentile":68864.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"29","median_amount":16753.73,"10th_percentile":12174.91,"90th_percentile":41851.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11615.1,"10th_percentile":11603.5,"90th_percentile":11834.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12407.46,"10th_percentile":12260.21,"90th_percentile":22167.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":52286.57,"10th_percentile":52286.57,"90th_percentile":52286.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12200.4,"10th_percentile":12200.4,"90th_percentile":12200.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11547.73,"10th_percentile":10563.06,"90th_percentile":11856.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":93630.23,"10th_percentile":93630.23,"90th_percentile":93630.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":48235.18,"10th_percentile":48235.18,"90th_percentile":48235.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":24183.61,"10th_percentile":24183.61,"90th_percentile":24183.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11971.63,"10th_percentile":11956.61,"90th_percentile":27033.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":74950.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27731.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26899.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49917.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27731.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":57796.75},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60687.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27731.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27454.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28008.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59384.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":42893.19},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":74950.57},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27731.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27849.89,"10th_percentile":27849.89,"90th_percentile":27849.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26302.7,"10th_percentile":26302.7,"90th_percentile":26302.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26524.27,"10th_percentile":26524.27,"90th_percentile":26524.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":54575.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20192.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19587.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36347.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20192.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":42084.76},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44189.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20192.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19990.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43241.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31232.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":54575.32},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20192.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":55604.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19956.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37032.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":42878.1},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45022.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20367.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20779.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44056.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31821.48},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":55604.13},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":86381.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57530.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":66611.71},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69943.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31641.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32280.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68442.09},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":49435.11},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":86381.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7388.22,"10th_percentile":7388.22,"90th_percentile":7388.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51275.07,"10th_percentile":51275.07,"90th_percentile":51275.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32037.93,"10th_percentile":32037.93,"90th_percentile":32037.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":42333.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15663.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15193.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28194.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15663.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":32644.74},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34277.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15663.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15506.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15820.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33541.76},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":24226.91},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":42333.54},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15663.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15201.71,"10th_percentile":15201.71,"90th_percentile":15201.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28191.5,"10th_percentile":28191.5,"90th_percentile":28191.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15505.63,"10th_percentile":15505.63,"90th_percentile":15505.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":27751.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10268.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9960.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18482.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10268.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21400.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22470.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10268.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10370.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21988.36},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15882.0},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27751.84},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10268.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42938.0,"10th_percentile":42938.0,"90th_percentile":42938.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10365.57,"10th_percentile":10365.57,"90th_percentile":10365.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10891.83,"10th_percentile":10891.83,"90th_percentile":10891.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":79611.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29456.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53021.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29456.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":61390.85},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64461.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29456.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29161.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29750.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63077.77},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":45560.51},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":79611.38},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29456.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":78004.0,"10th_percentile":50949.0,"90th_percentile":146686.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27686.13,"10th_percentile":27645.76,"90th_percentile":27686.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27951.41,"10th_percentile":26814.72,"90th_percentile":29968.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28218.11,"10th_percentile":28218.11,"90th_percentile":28218.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":45514.81,"10th_percentile":45514.81,"90th_percentile":45514.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":41519.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15362.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14901.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27651.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15362.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":32017.0},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33618.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15362.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15208.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32896.78},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23761.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":41519.5},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15362.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13198.89,"10th_percentile":13198.89,"90th_percentile":13198.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49489.86,"10th_percentile":28055.0,"90th_percentile":71286.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14897.84,"10th_percentile":14897.84,"90th_percentile":15147.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14590.53,"10th_percentile":14040.59,"90th_percentile":16015.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":32268.76,"10th_percentile":32268.76,"90th_percentile":32268.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15564.38,"10th_percentile":15564.38,"90th_percentile":15564.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14668.85,"10th_percentile":14668.85,"90th_percentile":15128.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":23428.99,"10th_percentile":23428.99,"90th_percentile":23428.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15290.59,"10th_percentile":15290.59,"90th_percentile":15290.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":29147.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10784.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10461.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19412.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10784.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22476.81},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23600.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10784.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10676.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10892.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23094.44},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16680.9},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29147.83},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10784.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11048.84,"10th_percentile":11048.84,"90th_percentile":11048.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":34875.21,"10th_percentile":34875.21,"90th_percentile":34875.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13656.0,"10th_percentile":8926.0,"90th_percentile":22610.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10708.56,"10th_percentile":10708.56,"90th_percentile":10708.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9922.23,"10th_percentile":9922.23,"90th_percentile":9922.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10511.23,"10th_percentile":10511.23,"90th_percentile":10511.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":62710.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23202.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22506.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41765.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23202.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":48358.07},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50776.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23202.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22970.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23434.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49686.87},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35888.38},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":62710.52},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23202.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":40566.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15009.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14559.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27017.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15009.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":31282.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32847.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15009.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14859.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15159.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32142.01},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23215.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":40566.9},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15009.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":28368.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10181.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18893.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21875.79},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22969.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10391.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22476.9},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16234.86},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28368.43},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":61847.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22883.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22197.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41190.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22883.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":47692.94},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50078.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22883.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22654.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23112.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49003.46},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35394.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":61847.99},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22883.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31864.0,"10th_percentile":31864.0,"90th_percentile":40768.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22077.92,"10th_percentile":22077.92,"90th_percentile":22077.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":34063.96,"10th_percentile":34063.96,"90th_percentile":34063.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20537.93,"10th_percentile":20537.93,"90th_percentile":20537.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":36522.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13513.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24324.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13513.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28163.8},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29572.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13513.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28937.69},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20901.43},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36522.68},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13513.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44408.0,"10th_percentile":44408.0,"90th_percentile":44408.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13345.9,"10th_percentile":13345.9,"90th_percentile":13345.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12381.17,"10th_percentile":12381.17,"90th_percentile":12381.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":26586.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9541.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17706.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20501.46},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21526.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9738.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9935.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21064.81},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15214.92},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26586.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":3128.02,"10th_percentile":3128.02,"90th_percentile":3128.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":4037.0,"10th_percentile":4037.0,"90th_percentile":4037.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":4552.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":3389.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":4552.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":7623.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":7623.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":44734.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16055.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29792.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":34495.88},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36221.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16551.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16386.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35443.76},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":25600.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":44734.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16551.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":26061.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9642.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17356.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9642.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20096.77},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21101.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9642.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9546.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9739.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20649.0},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14914.59},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26061.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9642.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8440.21,"10th_percentile":8440.21,"90th_percentile":8440.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":20544.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7601.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7373.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13682.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7601.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15842.89},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16635.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7601.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7525.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16278.22},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11757.61},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20544.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7601.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3065.71,"10th_percentile":3065.71,"90th_percentile":3065.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":39759.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14711.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14269.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26479.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14711.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":30660.03},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32193.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14711.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14563.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31502.52},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":22753.99},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":39759.79},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14711.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":22668.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8387.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8135.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15097.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8387.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17480.33},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18354.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8387.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8303.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8471.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17960.66},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12972.83},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22668.42},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8387.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7388.86,"10th_percentile":7388.86,"90th_percentile":7388.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15078.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5579.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5411.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10042.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5579.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11627.73},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12209.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5579.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5523.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5634.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11947.24},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8629.39},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15078.79},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5579.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":43159.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15490.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28744.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":33281.82},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34946.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15809.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16128.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34196.34},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":24699.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":43159.71},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40167.0,"10th_percentile":40167.0,"90th_percentile":40167.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":119375.33,"10th_percentile":119375.33,"90th_percentile":119375.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":26404.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9476.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17585.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20361.22},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21379.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9671.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9867.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20920.71},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15110.84},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26404.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9079.0,"10th_percentile":9079.0,"90th_percentile":9079.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4956.49,"10th_percentile":4956.49,"90th_percentile":4956.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10676.56,"10th_percentile":10676.56,"90th_percentile":10676.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10152.34,"10th_percentile":10152.34,"90th_percentile":10152.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":20226.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7259.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13470.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15597.14},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16377.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7408.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16025.72},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11575.23},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20226.3},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59.03,"10th_percentile":59.03,"90th_percentile":59.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7024.12,"10th_percentile":7024.12,"90th_percentile":7024.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":11954.53,"10th_percentile":11954.53,"90th_percentile":11954.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":9150.93,"10th_percentile":9150.93,"90th_percentile":9150.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":50262.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18597.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18039.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33474.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18597.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":38759.11},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40697.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18597.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18411.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18783.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39824.15},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":28764.62},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":50262.64},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18597.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18119.62,"10th_percentile":18119.62,"90th_percentile":18119.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19018.54,"10th_percentile":19018.54,"90th_percentile":19018.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":29071.9,"10th_percentile":29071.9,"90th_percentile":29071.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36617.3,"10th_percentile":36617.3,"90th_percentile":36617.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":29139.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10781.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10458.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19406.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10781.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22470.13},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23593.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10781.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10673.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10889.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23087.58},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16675.95},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29139.17},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10781.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10085.12,"10th_percentile":10085.12,"90th_percentile":10085.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":16861.3,"10th_percentile":16861.3,"90th_percentile":16861.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10541.13,"10th_percentile":10541.13,"90th_percentile":10541.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":23295.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8619.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15514.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8619.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17963.82},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18862.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8619.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8533.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8705.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18457.44},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13331.64},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23295.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8619.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6635.78,"10th_percentile":6635.78,"90th_percentile":83853.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5643.91,"10th_percentile":5643.91,"90th_percentile":5643.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":18295.5,"10th_percentile":18295.5,"90th_percentile":18295.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":2621.4,"10th_percentile":2621.4,"90th_percentile":2621.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":76083.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28150.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27306.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50671.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28150.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":58670.24},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61604.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28150.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27869.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28432.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60282.39},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":43541.43},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":76083.3},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28150.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26290.13,"10th_percentile":26290.13,"90th_percentile":26290.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25709.29,"10th_percentile":25709.29,"90th_percentile":25709.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":40277.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14902.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14455.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26824.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14902.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":31059.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32612.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14902.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14753.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31912.84},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23050.36},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":40277.66},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14902.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14624.06,"10th_percentile":14624.06,"90th_percentile":14624.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27093.6,"10th_percentile":27093.6,"90th_percentile":27093.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15318.46,"10th_percentile":15318.46,"90th_percentile":15318.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":24211.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8958.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16124.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8958.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18670.35},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19604.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8958.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8868.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9047.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19183.38},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13855.98},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24211.63},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8958.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":27571.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10201.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9895.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18362.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10201.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21261.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22324.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10201.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10099.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10303.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21845.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15778.91},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27571.71},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10201.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":16553.04,"10th_percentile":16553.04,"90th_percentile":16553.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8753.76,"10th_percentile":8753.76,"90th_percentile":8753.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":17323.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6217.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11537.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13358.67},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14026.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6345.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6473.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13725.74},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9913.98},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17323.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29684.84,"10th_percentile":29684.84,"90th_percentile":29684.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7250.29,"10th_percentile":7250.29,"90th_percentile":7250.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":12137.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4491.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4356.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8083.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4491.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9359.88},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9828.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4491.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4446.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4535.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9617.08},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6946.33},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12137.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4491.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":30710.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11021.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20452.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23681.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24865.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11249.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11476.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24332.25},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17574.97},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30710.09},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11362.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11244.97,"10th_percentile":11244.97,"90th_percentile":11244.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10609.31,"10th_percentile":10609.31,"90th_percentile":10609.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":17326.18,"10th_percentile":17326.18,"90th_percentile":113884.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":17683.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6542.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6346.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11777.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6542.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13636.48},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14318.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6542.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6608.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14011.18},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10120.15},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17683.72},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6542.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10642.21,"10th_percentile":10642.21,"90th_percentile":10642.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5438.99,"10th_percentile":5438.99,"90th_percentile":5438.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7246.41,"10th_percentile":7246.41,"90th_percentile":7246.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":10202.42,"10th_percentile":10202.42,"90th_percentile":10202.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5114.73,"10th_percentile":5114.73,"90th_percentile":5114.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":12598.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4661.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4521.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8390.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4661.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9715.15},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10201.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4661.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4614.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4708.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9982.11},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7209.99},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12598.57},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4661.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":37042.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13705.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13294.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24670.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13705.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28564.48},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29993.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13705.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13568.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13842.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29349.38},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21198.79},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":37042.28},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13705.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18360.0,"10th_percentile":18360.0,"90th_percentile":18360.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":20950.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7751.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13952.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7751.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16155.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16963.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7751.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7674.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7829.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16599.34},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11989.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20950.27},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7751.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":16008.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10661.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12344.95},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12962.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5864.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12684.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9161.66},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16008.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":31660.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11363.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21086.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24414.77},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25635.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11597.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11831.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25085.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18119.14},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31660.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11283.59,"10th_percentile":11283.59,"90th_percentile":12009.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31693.18,"10th_percentile":19989.94,"90th_percentile":45288.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11081.21,"10th_percentile":10228.61,"90th_percentile":11649.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22059.43,"10th_percentile":22059.43,"90th_percentile":22059.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12644.84,"10th_percentile":11857.7,"90th_percentile":12647.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10717.34,"10th_percentile":10717.34,"90th_percentile":10717.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11768.21,"10th_percentile":11768.21,"90th_percentile":11768.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":14057.09,"10th_percentile":14057.09,"90th_percentile":18022.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12010.14,"10th_percentile":12010.14,"90th_percentile":12010.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":16985.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6284.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6096.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11312.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6284.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13098.23},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13753.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6284.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6221.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6347.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13458.15},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9720.7},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16985.72},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6284.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6571.59,"10th_percentile":6571.59,"90th_percentile":6571.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":7796.34,"10th_percentile":2923.01,"90th_percentile":16945.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6989.76,"10th_percentile":6122.26,"90th_percentile":7178.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12970.48,"10th_percentile":12970.48,"90th_percentile":12970.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6215.27,"10th_percentile":5315.63,"90th_percentile":7414.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5866.46,"10th_percentile":5866.46,"90th_percentile":5893.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7205.7,"10th_percentile":7205.7,"90th_percentile":7205.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":2392.53,"10th_percentile":2392.53,"90th_percentile":2392.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":9121.47,"10th_percentile":9121.47,"90th_percentile":9772.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7061.59,"10th_percentile":7061.57,"90th_percentile":7084.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":10918.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3918.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7271.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8419.62},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8840.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3999.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4080.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8650.98},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6248.52},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":10918.53},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4039.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1030.7,"10th_percentile":1030.7,"90th_percentile":1030.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4985.5,"10th_percentile":4985.5,"90th_percentile":4985.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":33985.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12574.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12197.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12574.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26207.14},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27517.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12574.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12448.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12700.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26927.27},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19449.33},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33985.3},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12574.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18766.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6735.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12498.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14471.23},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15195.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7012.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14868.87},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10739.65},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18766.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3389.0,"10th_percentile":3389.0,"90th_percentile":3389.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":8920.51,"10th_percentile":8920.51,"90th_percentile":8920.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13866.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5130.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9235.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5130.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10692.81},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11227.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5130.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5079.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5181.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10986.63},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7935.55},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13866.39},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5130.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4632.75,"10th_percentile":4632.75,"90th_percentile":4632.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":23913.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8848.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8582.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15926.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8848.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18440.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19362.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8848.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8759.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8936.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18947.35},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13685.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23913.72},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8848.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6414.64,"10th_percentile":6414.64,"90th_percentile":6414.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8672.72,"10th_percentile":8672.72,"90th_percentile":8672.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":14805.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5477.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5313.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9860.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5477.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11416.71},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11987.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5477.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5423.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11730.42},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8472.78},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14805.14},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5477.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39.09,"10th_percentile":39.09,"90th_percentile":39.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2673.99,"10th_percentile":2673.99,"90th_percentile":2673.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5930.95,"10th_percentile":5930.95,"90th_percentile":5930.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":27405.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10140.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9835.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18252.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10140.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21133.2},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22190.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10140.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10038.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21713.9},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15683.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27405.44},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10140.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":16105.02,"10th_percentile":16105.02,"90th_percentile":16105.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":16909.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11261.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13039.46},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13691.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6319.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13397.76},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9677.09},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16909.52},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10606.68,"10th_percentile":10606.68,"90th_percentile":10606.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":4015.94,"10th_percentile":4015.94,"90th_percentile":4015.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6323.46,"10th_percentile":6323.46,"90th_percentile":6323.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":11800.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4235.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7858.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9099.44},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9554.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4322.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4409.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9349.48},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6753.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11800.12},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4366.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14709.32,"10th_percentile":14709.32,"90th_percentile":14709.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":25578.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9463.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9179.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17035.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9463.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19724.14},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20710.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9463.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9369.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9558.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20266.13},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14638.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25578.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9463.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12685.0,"10th_percentile":12685.0,"90th_percentile":20400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8294.55,"10th_percentile":8294.55,"90th_percentile":8294.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13679.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5061.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4909.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9110.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5061.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10548.57},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11076.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5061.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5111.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10838.43},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7828.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13679.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5061.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2347.45,"10th_percentile":2347.45,"90th_percentile":2347.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":13384.87,"10th_percentile":13384.87,"90th_percentile":13384.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7340.68,"10th_percentile":4875.0,"90th_percentile":12750.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5498.72,"10th_percentile":4266.63,"90th_percentile":5804.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4741.1,"10th_percentile":4741.1,"90th_percentile":5972.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5912.36,"10th_percentile":5912.36,"90th_percentile":5912.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7945.46,"10th_percentile":7945.46,"90th_percentile":7945.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5966.09,"10th_percentile":5966.09,"90th_percentile":5966.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":9422.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3486.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3381.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6275.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3486.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":7265.66},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7629.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3486.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3451.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3521.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7465.31},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":5392.13},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":9422.08},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3486.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":689.28,"10th_percentile":689.28,"90th_percentile":689.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1204.47,"10th_percentile":1204.47,"90th_percentile":2548.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4476.22,"10th_percentile":4476.22,"90th_percentile":4476.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":4610.27,"10th_percentile":4610.27,"90th_percentile":4610.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4461.09,"10th_percentile":4461.09,"90th_percentile":4461.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":21966.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14629.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16939.41},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17786.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8209.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17404.88},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12571.39},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":21966.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8909.66,"10th_percentile":8909.66,"90th_percentile":8909.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8040.16,"10th_percentile":8040.16,"90th_percentile":8040.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8044.43,"10th_percentile":8044.43,"90th_percentile":8622.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8836.88,"10th_percentile":8836.88,"90th_percentile":8836.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":12731.96,"10th_percentile":12731.96,"90th_percentile":12731.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":11961.0,"10th_percentile":11961.0,"90th_percentile":11961.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1954.35,"10th_percentile":1954.35,"90th_percentile":1954.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13502.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4995.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4846.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8992.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4995.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10412.34},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10933.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4995.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4946.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5045.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10698.45},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7727.4},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13502.67},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4995.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2858.06,"10th_percentile":2858.06,"90th_percentile":5094.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":3963.11,"10th_percentile":3963.11,"90th_percentile":3963.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":6778.0,"10th_percentile":970.13,"90th_percentile":16945.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2447.06,"10th_percentile":2447.06,"90th_percentile":5687.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5680.37,"10th_percentile":4631.77,"90th_percentile":6131.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5958.48,"10th_percentile":5958.48,"90th_percentile":5958.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2345.88,"10th_percentile":2345.88,"90th_percentile":5806.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":2653.7,"10th_percentile":1315.5,"90th_percentile":7734.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":8074.0,"10th_percentile":8074.0,"90th_percentile":8074.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5839.22,"10th_percentile":5839.22,"90th_percentile":5861.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":27699.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10248.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9941.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18448.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10248.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21360.25},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22428.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10248.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10351.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21947.19},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15852.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27699.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10248.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7850.0,"10th_percentile":7850.0,"90th_percentile":7850.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10754.79,"10th_percentile":10754.79,"90th_percentile":10754.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4301.53,"10th_percentile":4301.53,"90th_percentile":4301.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10098.66,"10th_percentile":6068.17,"90th_percentile":10863.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9895.56,"10th_percentile":9895.56,"90th_percentile":9895.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9989.08,"10th_percentile":9989.08,"90th_percentile":10979.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":16206.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5996.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5816.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10793.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5996.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12497.21},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13122.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5996.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12840.61},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9274.66},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16206.32},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5996.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6646.0,"10th_percentile":6396.0,"90th_percentile":13556.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6592.76,"10th_percentile":6592.76,"90th_percentile":6592.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12529.15,"10th_percentile":12529.15,"90th_percentile":12529.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":9330.17,"10th_percentile":9330.17,"90th_percentile":9330.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":7838.0,"10th_percentile":7838.0,"90th_percentile":7838.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6828.95,"10th_percentile":6828.95,"90th_percentile":7307.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":11240.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4159.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4034.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7486.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4159.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8668.04},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9101.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4159.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4117.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4200.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8906.23},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6432.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11240.68},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4159.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1415.25,"10th_percentile":1415.25,"90th_percentile":1415.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4395.05,"10th_percentile":4395.05,"90th_percentile":4395.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":977.21,"10th_percentile":977.21,"90th_percentile":977.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":41479.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15347.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27625.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15347.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":31986.28},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33586.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15347.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15193.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15500.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32865.21},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23738.25},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":41479.67},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15347.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":113945.0,"10th_percentile":113945.0,"90th_percentile":113945.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15470.92,"10th_percentile":15470.92,"90th_percentile":15470.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15895.5,"10th_percentile":15895.5,"90th_percentile":15895.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":26215.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9408.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17459.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20215.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21226.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9602.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9796.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20771.13},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15002.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26215.55},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5661.0,"10th_percentile":5551.0,"90th_percentile":28305.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10092.52,"10th_percentile":9908.29,"90th_percentile":10383.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10118.39,"10th_percentile":10118.39,"90th_percentile":10118.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":5127.72,"10th_percentile":5127.72,"90th_percentile":5127.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":19826.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7335.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7115.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13204.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7335.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15288.61},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16053.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7335.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7262.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7409.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15708.72},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11346.27},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19826.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7335.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":18440.36,"10th_percentile":18440.36,"90th_percentile":18440.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":8727.55,"10th_percentile":5661.0,"90th_percentile":11172.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7656.83,"10th_percentile":7656.83,"90th_percentile":7656.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7882.79,"10th_percentile":7882.79,"90th_percentile":7882.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":11837.09,"10th_percentile":11837.09,"90th_percentile":11837.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":3133.44,"10th_percentile":3133.44,"90th_percentile":9816.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":5303.0,"10th_percentile":5303.0,"90th_percentile":5303.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":69635.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25764.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24991.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46376.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25764.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":53697.8},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56383.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25764.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25507.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26022.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55173.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":39851.2},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":69635.06},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25764.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":94749.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35057.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34005.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63102.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35057.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":73064.0},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76718.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35057.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34706.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75071.67},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":54223.6},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":94749.06},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35057.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":50231.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18585.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18028.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33454.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18585.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":38735.07},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40672.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18585.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18399.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18771.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39799.44},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":28746.78},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":50231.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18585.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":38443.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14224.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25603.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14224.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29644.98},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31127.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14224.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14081.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14366.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30459.57},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":22000.68},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":38443.47},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14224.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":61756.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22849.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22164.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41129.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22849.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":47622.15},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50003.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22849.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22621.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23078.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48930.73},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35342.23},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":61756.19},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22849.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28431.51,"10th_percentile":28431.51,"90th_percentile":28431.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":37710.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13952.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25115.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13952.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29080.02},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30534.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13952.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14092.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29879.09},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21581.4},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":37710.84},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13952.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":27498.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10174.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9869.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18314.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10174.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21205.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22265.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10174.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10072.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10276.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21788.01},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15737.28},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27498.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10174.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3389.0,"10th_percentile":3389.0,"90th_percentile":3389.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":57213.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20533.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38103.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":44118.87},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46325.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20957.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21380.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45331.19},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":32742.31},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":57213.16},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":25466.93,"10th_percentile":25466.93,"90th_percentile":25466.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":36415.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13069.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24252.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28080.99},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29485.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13338.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13608.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28852.61},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20839.98},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36415.3},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13473.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":28759.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19154.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22177.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23286.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10747.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22787.04},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16458.88},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28759.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10641.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4552.0,"10th_percentile":4552.0,"90th_percentile":4552.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":61704.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22830.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22145.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41094.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22830.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":47582.09},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49961.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22830.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22602.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23058.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48889.56},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35312.49},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":61704.23},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22830.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12989.33,"10th_percentile":12989.33,"90th_percentile":12989.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":35795.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12846.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23839.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27602.85},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28983.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13111.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13376.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28361.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20485.13},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":35795.24},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12601.0,"10th_percentile":12601.0,"90th_percentile":12601.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10755.56,"10th_percentile":10755.56,"90th_percentile":10755.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":23612.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8474.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15725.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18208.23},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19118.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8649.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8823.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18708.57},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13513.03},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23612.36},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8605.41,"10th_percentile":8605.41,"90th_percentile":8605.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":11240.68,"10th_percentile":11240.68,"90th_percentile":11240.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":41332.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15292.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14834.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27527.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15292.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":31872.76},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33466.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15292.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15140.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15445.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32748.57},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23654.0},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":41332.45},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15292.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27692.0,"10th_percentile":15246.0,"90th_percentile":31734.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12879.91,"10th_percentile":12879.91,"90th_percentile":14875.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3200.0,"10th_percentile":3200.0,"90th_percentile":3200.0},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":286031.38,"10th_percentile":286031.38,"90th_percentile":286031.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11097.55,"10th_percentile":11097.55,"90th_percentile":11097.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":29298.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10840.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19512.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10840.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22593.01},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23723.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10840.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10948.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23213.83},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16767.14},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29298.51},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10840.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":16233.0,"10th_percentile":10952.0,"90th_percentile":33966.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11194.4,"10th_percentile":11194.4,"90th_percentile":11194.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11285.77,"10th_percentile":11285.77,"90th_percentile":11285.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10975.24,"10th_percentile":10975.24,"90th_percentile":10975.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":14203.73,"10th_percentile":14203.73,"90th_percentile":14203.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":5312.0,"10th_percentile":5312.0,"90th_percentile":5312.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9663.07,"10th_percentile":9663.07,"90th_percentile":9663.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":23655.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8490.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15754.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18241.62},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19153.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8665.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18742.87},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13537.81},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23655.66},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9005.4,"10th_percentile":9005.4,"90th_percentile":9005.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7623.0,"10th_percentile":6239.09,"90th_percentile":15246.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8762.82,"10th_percentile":8762.82,"90th_percentile":8762.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15637.52,"10th_percentile":15637.52,"90th_percentile":15637.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":16400.41,"10th_percentile":16400.41,"90th_percentile":16400.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":3130.48,"10th_percentile":3130.48,"90th_percentile":3130.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":59010.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21834.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21179.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39301.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21834.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":45505.23},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47781.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21834.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21615.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22052.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46755.63},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":33771.18},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":59010.97},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21834.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":30093.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20042.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23206.05},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24366.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11023.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11245.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23843.71},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17222.1},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30093.5},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":24239.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8968.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8699.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16143.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8968.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18691.72},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19626.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8968.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8878.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9058.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19205.34},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13871.84},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24239.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8968.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":71929.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26614.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25815.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47905.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26614.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":55467.47},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58241.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26614.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26347.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26880.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56991.62},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":41164.54},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":71929.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26614.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":37894.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13600.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25237.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29221.59},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30683.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13880.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14161.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30024.55},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21686.46},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":37894.43},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":25985.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9326.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17306.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20038.01},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21040.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9518.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9710.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20588.62},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14870.97},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25985.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":190887.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68509.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":127130.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":147199.15},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":154561.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70628.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69921.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71334.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":151243.93},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":109242.13},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":190887.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70628.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":125026.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46259.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44871.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83267.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46259.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":96411.62},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":101233.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46259.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45797.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46722.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99060.85},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":71550.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":125026.15},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46259.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":97373.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36027.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34947.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64850.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36027.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":75087.43},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78842.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36027.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35667.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36388.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77150.71},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":55725.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":97373.04},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36027.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":156046.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56004.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103926.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":120332.22},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":126350.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57159.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58314.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":123638.74},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":89303.16},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":156046.27},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57737.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":99886.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36957.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35849.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66524.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36957.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":77025.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80877.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36957.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36588.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37327.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79141.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":57163.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":99886.17},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36957.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35411.07,"10th_percentile":35411.07,"90th_percentile":35411.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":34089.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12613.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12234.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22703.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12613.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26287.28},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27602.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12613.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12739.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27009.61},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19508.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34089.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12613.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10802.5,"10th_percentile":10802.5,"90th_percentile":10802.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16945.0,"10th_percentile":16945.0,"90th_percentile":16945.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12462.19,"10th_percentile":12273.79,"90th_percentile":12462.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12113.7,"10th_percentile":12113.7,"90th_percentile":12113.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10406.34,"10th_percentile":10406.34,"90th_percentile":10406.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":19418.6,"10th_percentile":19418.6,"90th_percentile":19418.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":20517.0,"10th_percentile":20517.0,"90th_percentile":20517.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12847.6,"10th_percentile":7021.41,"90th_percentile":12858.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":18293.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6768.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6565.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12183.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6768.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14106.61},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14812.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6768.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6700.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14494.23},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10469.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18293.38},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6768.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7650.0,"10th_percentile":2547.86,"90th_percentile":17223.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4924.25,"10th_percentile":4924.25,"90th_percentile":4924.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":10603.86,"10th_percentile":10603.86,"90th_percentile":10603.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8917.1,"10th_percentile":8917.1,"90th_percentile":8917.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":12340.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4429.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8218.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9516.15},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9992.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4611.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9777.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7062.3},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12340.5},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4565.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":31811.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21186.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24530.97},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25757.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11652.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25205.03},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18205.37},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31811.64},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11927.71,"10th_percentile":11927.71,"90th_percentile":11927.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":19590.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7031.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13047.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15106.97},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15862.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7176.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7321.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15522.09},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11211.46},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19590.65},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":14779.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5468.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5304.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9842.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5468.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11396.67},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11966.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5468.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5413.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5522.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11709.84},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8457.91},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14779.16},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5468.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":28235.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10446.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18804.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10446.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21772.95},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22861.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10446.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10342.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10551.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22371.23},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16158.54},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28235.06},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10446.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4672.0,"10th_percentile":4672.0,"90th_percentile":4672.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10813.67,"10th_percentile":10813.67,"90th_percentile":10813.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11645.93,"10th_percentile":11645.93,"90th_percentile":11645.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":32962.25,"10th_percentile":32962.25,"90th_percentile":32962.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10262.07,"10th_percentile":10262.07,"90th_percentile":10262.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":16490.59,"10th_percentile":16490.59,"90th_percentile":16490.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":14569.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5390.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5229.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9703.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5390.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11235.07},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11796.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5390.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5336.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5444.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11543.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8337.97},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14569.58},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5390.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5885.36,"10th_percentile":5885.36,"90th_percentile":5885.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":20908.66,"10th_percentile":20908.66,"90th_percentile":20908.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6600.0,"10th_percentile":2300.0,"90th_percentile":13400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5597.8,"10th_percentile":5597.8,"90th_percentile":5597.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5877.82,"10th_percentile":5877.82,"90th_percentile":5877.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6837.34,"10th_percentile":6837.34,"90th_percentile":6837.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":10762.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3862.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7167.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8299.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8714.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3942.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4021.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8527.47},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6159.32},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":10762.65},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3982.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12505.0,"10th_percentile":12505.0,"90th_percentile":12505.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":6152.29,"10th_percentile":6152.29,"90th_percentile":6152.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7534.33,"10th_percentile":7534.33,"90th_percentile":7534.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":31084.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11501.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11156.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20702.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11501.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23970.01},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25168.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11501.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11386.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11616.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24628.67},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17789.07},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31084.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11501.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11900.16,"10th_percentile":10567.59,"90th_percentile":20265.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15608.0,"10th_percentile":4552.0,"90th_percentile":18208.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12066.22,"10th_percentile":12066.22,"90th_percentile":12066.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":38239.39,"10th_percentile":38239.39,"90th_percentile":38239.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":16719.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6186.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6000.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11134.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6186.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12892.55},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13537.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6186.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6247.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13246.81},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9568.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16719.0},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6186.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5100.0,"10th_percentile":4988.5,"90th_percentile":9275.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6136.17,"10th_percentile":6136.17,"90th_percentile":6136.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":12118.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4483.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4349.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8071.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4483.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9345.19},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9812.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4483.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4439.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4528.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9601.98},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6935.43},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12118.8},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4483.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":28939.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19274.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22316.54},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23432.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10600.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10814.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22929.76},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16561.96},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28939.99},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10707.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6152.06,"10th_percentile":6152.06,"90th_percentile":6152.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10203.72,"10th_percentile":10203.72,"90th_percentile":10203.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18955.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7013.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6802.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12624.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7013.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14616.81},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15347.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7013.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15018.45},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10847.69},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18955.01},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7013.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7424.15,"10th_percentile":7424.15,"90th_percentile":7424.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":14328.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5142.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9542.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11049.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11602.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5248.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5354.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11353.04},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8200.2},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14328.84},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":115725.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42818.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41533.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77072.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42818.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":89239.45},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":93702.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42818.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42390.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43246.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91691.6},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":66228.02},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":115725.31},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42818.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":73450.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27176.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26361.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48918.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27176.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":56640.12},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59472.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27176.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26904.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27448.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58196.5},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":42034.81},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":73450.66},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27176.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":92308.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34154.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33129.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61477.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34154.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":71182.14},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74742.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34154.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33812.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34495.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73138.1},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":52827.0},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":92308.67},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34154.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":55950.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20701.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20080.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37263.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20701.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":43145.22},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45303.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20701.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20494.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20908.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44330.78},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":32019.72},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":55950.53},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20701.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63525.0,"10th_percentile":63525.0,"90th_percentile":63525.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":145546.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53852.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52236.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":96934.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53852.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":112235.81},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":117849.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53852.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53313.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54390.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115319.86},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":83294.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":145546.89},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53852.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":103280.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38213.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37067.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68784.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38213.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":79643.16},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":83626.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38213.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37831.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38596.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81831.62},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":59106.25},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":103280.89},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38213.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":72269.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26739.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25937.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48131.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26739.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":55729.25},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58516.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26739.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26472.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27007.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57260.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":41358.81},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":72269.43},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26739.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":95658.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35393.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34331.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63708.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35393.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":73765.19},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":77454.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35393.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35039.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35747.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75792.13},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":54743.98},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":95658.36},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35393.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":46071.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17046.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16534.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30683.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17046.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":35526.96},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37303.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17046.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16875.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17216.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36503.18},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":26365.92},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":46071.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17046.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":98715.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36524.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35428.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65744.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36524.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":76122.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":79929.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36524.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36159.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36889.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78214.24},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":56493.44},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":98715.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36524.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32311.82,"10th_percentile":32311.82,"90th_percentile":32311.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":53534.71,"10th_percentile":53534.71,"90th_percentile":53534.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16525.94,"10th_percentile":16525.94,"90th_percentile":16525.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":53946.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19960.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19361.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35928.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19960.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":41599.93},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43680.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19960.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19760.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20159.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42743.03},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":30872.91},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":53946.6},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19960.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44741.7,"10th_percentile":44741.7,"90th_percentile":44741.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14647.48,"10th_percentile":14647.48,"90th_percentile":14647.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17462.78,"10th_percentile":17462.78,"90th_percentile":17462.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18543.22,"10th_percentile":18543.22,"90th_percentile":18543.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":3109.0,"10th_percentile":3109.0,"90th_percentile":3109.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16525.75,"10th_percentile":16525.75,"90th_percentile":16525.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":31586.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11336.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21036.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24357.34},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25575.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11570.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11803.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25026.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18076.51},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31586.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":90157.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32357.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60044.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":69523.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73000.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33358.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33024.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33691.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71433.7},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":51595.92},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":90157.53},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33358.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19818.37,"10th_percentile":19818.37,"90th_percentile":19818.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":61080.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22599.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21921.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40679.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22599.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":47101.27},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49457.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22599.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22373.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22825.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48395.53},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":34955.66},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":61080.71},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22599.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14782.51,"10th_percentile":14782.51,"90th_percentile":14782.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20834.8,"10th_percentile":20834.8,"90th_percentile":20834.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21197.03,"10th_percentile":21197.03,"90th_percentile":21197.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":47595.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17081.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31698.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":36702.29},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38537.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17434.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17786.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37710.8},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":27238.18},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":47595.36},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16973.38,"10th_percentile":16973.38,"90th_percentile":16973.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16804.01,"10th_percentile":16804.01,"90th_percentile":16804.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":52535.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19437.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18854.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34988.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19437.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":40511.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42537.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19437.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19243.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19632.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41624.6},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":30065.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":52535.02},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19437.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18506.83,"10th_percentile":18506.83,"90th_percentile":18506.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19838.24,"10th_percentile":19838.24,"90th_percentile":19838.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21915.77,"10th_percentile":21915.77,"90th_percentile":21915.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11990.32,"maximum":33408.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12361.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11990.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22250.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12361.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25762.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27050.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12361.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12237.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12484.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26470.29},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19119.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33408.55},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12361.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10704.08,"10th_percentile":10704.08,"90th_percentile":10704.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25410.0,"10th_percentile":23214.34,"90th_percentile":38115.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12048.75,"10th_percentile":11673.22,"90th_percentile":12570.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13030.52,"10th_percentile":13030.52,"90th_percentile":13030.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":350.0,"10th_percentile":350.0,"90th_percentile":11368.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":46183.9,"10th_percentile":46183.9,"90th_percentile":46183.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":38621.5,"10th_percentile":38621.5,"90th_percentile":38621.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11098.98,"10th_percentile":200.0,"90th_percentile":12421.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":83633.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30944.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30015.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55699.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30944.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":64492.12},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67717.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30944.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30634.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31253.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66264.25},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":47862.07},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":83633.08},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30944.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":70314.38,"10th_percentile":70314.38,"90th_percentile":70314.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":51026.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18879.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18313.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33983.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18879.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":39348.11},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41316.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18879.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18690.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19068.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40429.33},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":29201.74},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":51026.45},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18879.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12705.0,"10th_percentile":12705.0,"90th_percentile":36514.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17304.15,"10th_percentile":17304.15,"90th_percentile":17304.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":28421.36,"10th_percentile":28421.36,"90th_percentile":28421.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":42283.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15175.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28160.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":32606.0},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34236.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15488.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15801.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33501.96},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":24198.17},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":42283.32},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12458.0,"10th_percentile":12458.0,"90th_percentile":12458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14769.19,"10th_percentile":14769.19,"90th_percentile":14769.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16134.95,"10th_percentile":16134.95,"90th_percentile":16134.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":74353.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27510.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26685.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49519.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27510.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":57335.97},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60203.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27510.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27235.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27785.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58911.47},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":42551.22},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":74353.03},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27510.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26271.37,"10th_percentile":26271.37,"90th_percentile":26271.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":39415.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14583.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14146.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26250.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14583.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":30394.25},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31914.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14583.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14437.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14729.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31229.43},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":22556.74},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":39415.12},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14583.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20334.0,"10th_percentile":20334.0,"90th_percentile":20334.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20504.03,"10th_percentile":20504.03,"90th_percentile":20504.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13885.73,"10th_percentile":13885.73,"90th_percentile":13885.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":20441.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7336.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13613.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15762.75},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16551.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16195.88},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11698.14},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20441.06},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7563.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":59833.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22138.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21474.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39849.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22138.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":46139.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48447.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22138.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21917.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22359.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47407.48},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":34242.0},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":59833.67},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22138.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20996.99,"10th_percentile":20996.99,"90th_percentile":20996.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20548.4,"10th_percentile":20548.4,"90th_percentile":20548.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20509.1,"10th_percentile":20509.1,"90th_percentile":20509.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":42593.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15286.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28367.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":32845.08},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34487.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15601.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15917.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33747.6},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":24375.59},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":42593.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15759.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":32196.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11912.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11555.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21442.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11912.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24827.47},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26069.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11912.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11793.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25509.68},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18425.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":32196.15},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11912.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":50441.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18663.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18103.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18663.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":38896.68},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40842.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18663.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18476.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18849.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39965.49},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":28866.72},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":50441.04},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18663.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16921.71,"10th_percentile":16921.71,"90th_percentile":16921.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16704.02,"10th_percentile":16300.13,"90th_percentile":18943.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19657.67,"10th_percentile":19657.67,"90th_percentile":19657.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19498.84,"10th_percentile":19498.84,"90th_percentile":19498.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18498.87,"10th_percentile":18498.87,"90th_percentile":18542.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":69003.14,"10th_percentile":69003.14,"90th_percentile":69003.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18730.34,"10th_percentile":13082.06,"90th_percentile":18730.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":36276.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13019.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24160.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27974.14},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29373.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13288.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13556.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28742.82},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20760.68},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36276.74},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29625.0,"10th_percentile":29625.0,"90th_percentile":29625.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":13153.43,"10th_percentile":12102.36,"90th_percentile":13447.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23028.53,"10th_percentile":23028.53,"90th_percentile":23028.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13536.32,"10th_percentile":13013.37,"90th_percentile":14213.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10525.45,"10th_percentile":10525.45,"90th_percentile":13439.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13536.31,"10th_percentile":12895.52,"90th_percentile":13581.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":28248.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10452.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10138.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18813.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10452.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21783.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22873.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10452.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10347.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10556.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22382.21},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16166.47},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28248.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10452.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":56911.63,"10th_percentile":56911.63,"90th_percentile":56911.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15246.0,"10th_percentile":15246.0,"90th_percentile":22425.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10573.49,"10th_percentile":10573.49,"90th_percentile":10573.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":15724.4,"10th_percentile":15724.4,"90th_percentile":15724.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9745.11,"10th_percentile":9745.11,"90th_percentile":9745.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":48009.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17763.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17230.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31974.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17763.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":37021.5},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38873.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17763.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17585.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17941.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38038.78},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":27475.07},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":48009.31},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17763.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12735.0,"10th_percentile":12735.0,"90th_percentile":12735.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":55893.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20060.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37224.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":43101.15},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45256.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20473.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20887.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44285.49},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31987.02},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":55893.37},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":36217.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13400.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12998.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24121.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13400.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27928.73},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29325.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13400.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13266.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28696.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20726.98},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36217.85},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13400.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13435.89,"10th_percentile":13435.89,"90th_percentile":13435.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":27126.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10036.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9735.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18066.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10036.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20918.17},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21964.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10036.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21492.96},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15524.17},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27126.58},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10036.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":19516.57,"10th_percentile":19516.57,"90th_percentile":19516.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":30637.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11335.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10995.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20404.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11335.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23625.43},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24807.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11335.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11222.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11449.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24274.61},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17533.34},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30637.35},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11335.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12795.46,"10th_percentile":12795.46,"90th_percentile":12795.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6942.18,"maximum":19342.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12882.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14915.98},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15662.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7085.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7228.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15325.85},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11069.72},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19342.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":63592.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23529.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22823.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42352.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23529.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":49037.89},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51490.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23529.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23293.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23764.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50385.37},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":36392.9},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":63592.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23529.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21541.38,"10th_percentile":21541.38,"90th_percentile":21541.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22358.61,"10th_percentile":22358.61,"90th_percentile":22358.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":43925.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16252.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15764.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29254.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16252.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":33872.15},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35566.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16252.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16089.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16414.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34802.9},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":25137.82},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":43925.25},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16252.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45338.0,"10th_percentile":45338.0,"90th_percentile":45338.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15010.9,"10th_percentile":15010.9,"90th_percentile":15010.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13652.29,"10th_percentile":13652.29,"90th_percentile":14752.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":41333.29,"10th_percentile":41333.29,"90th_percentile":41333.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12332.5,"10th_percentile":12332.5,"90th_percentile":12332.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12472.69,"maximum":34752.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12858.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23145.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12858.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26798.81},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28139.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12858.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12729.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12987.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27535.2},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19888.43},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34752.58},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12858.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12409.67,"10th_percentile":12409.67,"90th_percentile":12409.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9185.68,"10th_percentile":5246.26,"90th_percentile":38115.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12060.58,"10th_percentile":12060.58,"90th_percentile":12060.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":19077.28,"10th_percentile":19077.28,"90th_percentile":19077.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":62797.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23234.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22537.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41822.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23234.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":48424.85},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50846.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23234.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23002.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23467.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49755.48},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35937.94},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":62797.12},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23234.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":31243.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11560.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20808.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11560.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24092.89},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25297.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11560.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11675.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24754.92},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17880.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31243.55},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11560.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12199.16,"10th_percentile":12199.16,"90th_percentile":12199.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7510.96,"maximum":20927.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7510.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13937.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16138.05},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16945.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7665.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16581.5},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11976.67},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20927.76},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":52250.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19332.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18752.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34799.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19332.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":40292.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42307.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19332.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19139.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19526.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41399.55},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":29902.52},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":52250.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19332.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":34896.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12911.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12524.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23240.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12911.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26909.67},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28255.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12911.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12782.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13040.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27649.1},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19970.7},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34896.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12911.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":54814.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20281.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19672.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36506.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20281.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":42269.07},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44383.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20281.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20078.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20484.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43430.55},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31369.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":54814.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20281.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":101898.0,"10th_percentile":101898.0,"90th_percentile":101898.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20259.71,"10th_percentile":20259.71,"90th_percentile":20259.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":30277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11202.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10866.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20164.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11202.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23347.62},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24515.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11202.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11090.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23989.18},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17327.17},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30277.09},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11202.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11740.45,"10th_percentile":11740.45,"90th_percentile":11740.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9561.85,"10th_percentile":9561.85,"90th_percentile":9561.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":13240.49,"10th_percentile":13240.49,"90th_percentile":13240.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":23310.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8366.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15525.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17975.84},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18874.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8538.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8711.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18469.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13340.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23310.99},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44850.0,"10th_percentile":44850.0,"90th_percentile":44850.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":12431.72,"10th_percentile":12431.72,"90th_percentile":12431.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":48341.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17886.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17349.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32195.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17886.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":37277.93},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39142.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17886.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17707.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18065.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38302.27},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":27665.38},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":48341.85},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17886.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16945.0,"10th_percentile":16945.0,"90th_percentile":16945.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":32374.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11619.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21561.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24965.04},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26213.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11858.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12098.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25651.03},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18527.51},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":32374.54},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4302.0,"10th_percentile":4302.0,"90th_percentile":4302.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11559.25,"10th_percentile":11559.25,"90th_percentile":11559.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":17395.56,"10th_percentile":17395.56,"90th_percentile":17395.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":31051.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11488.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20680.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11488.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23944.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25142.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11488.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11603.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24602.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17770.23},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31051.3},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11488.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":23368.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8386.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15563.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18019.92},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18921.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8559.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8732.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18515.07},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13373.27},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23368.14},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":31286.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11576.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20837.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11576.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24126.28},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25332.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11576.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11691.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24789.23},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17905.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31286.85},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11576.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":26229.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9704.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9413.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17468.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9704.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20226.33},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21237.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9704.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9607.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9801.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20782.11},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15010.73},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26229.41},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9704.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":5661.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22644.0,"10th_percentile":22644.0,"90th_percentile":22644.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":52315.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19356.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18775.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34841.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19356.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":40341.8},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42359.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19356.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19162.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19550.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41450.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":29939.2},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":52315.06},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19356.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":36015.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13325.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12925.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23986.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13325.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27772.47},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29161.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13325.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13192.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28535.61},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20611.01},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36015.21},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13325.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10290.20,"maximum":28671.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10290.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19095.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22109.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23215.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10502.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10714.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22717.05},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16408.32},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28671.53},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25410.0,"10th_percentile":25410.0,"90th_percentile":25410.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":27266.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18159.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21026.35},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22077.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10189.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21604.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15604.46},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27266.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":17706.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6551.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6354.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11792.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6551.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13653.84},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14336.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6551.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6485.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14029.02},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10133.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17706.24},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6551.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6647.12,"10th_percentile":6647.12,"90th_percentile":9138.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7055.43,"10th_percentile":7055.43,"90th_percentile":7055.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7215.33,"10th_percentile":7215.33,"90th_percentile":7215.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":55197.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20422.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19810.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36761.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20422.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":42564.24},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44693.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20422.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20218.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20627.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43733.83},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31588.55},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":55197.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20422.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":35992.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13317.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12917.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23971.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13317.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27755.1},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29143.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13317.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13184.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13450.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28517.77},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20598.13},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":35992.69},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13317.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":143.15,"10th_percentile":143.15,"90th_percentile":143.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12777.36,"10th_percentile":12777.36,"90th_percentile":12777.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11882.78,"10th_percentile":11882.78,"90th_percentile":11882.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":20598.13,"10th_percentile":20598.13,"90th_percentile":20598.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9552.34,"maximum":26615.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9847.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9552.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17725.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9847.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20524.17},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21550.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9847.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9749.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9946.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21088.13},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15231.77},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26615.64},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9847.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12705.0,"10th_percentile":12705.0,"90th_percentile":12705.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9973.95,"10th_percentile":9973.95,"90th_percentile":9973.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":64730.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23950.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23231.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43110.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23950.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":49915.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52411.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23950.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23710.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24189.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51286.97},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":37044.12},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":64730.04},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23950.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":34643.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12818.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12433.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23072.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12818.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26714.67},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28050.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12818.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12689.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12946.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27448.74},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19825.98},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34643.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12818.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10733.22,"10th_percentile":10733.22,"90th_percentile":10733.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":25874.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9286.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17232.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19952.53},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20950.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9477.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20500.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14807.54},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25874.35},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":49711.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18393.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33108.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18393.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":38334.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40251.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18393.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18209.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18577.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39387.75},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":28449.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":49711.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18393.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17542.85,"10th_percentile":17542.85,"90th_percentile":17542.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18340.15,"10th_percentile":18340.15,"90th_percentile":18340.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":36678.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13571.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13163.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24427.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13571.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28284.0},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29698.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13571.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13435.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13706.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29061.2},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20990.64},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36678.56},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13571.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13783.46,"10th_percentile":13783.46,"90th_percentile":13783.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13350.71,"10th_percentile":13321.68,"90th_percentile":13981.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13733.69,"10th_percentile":13733.69,"90th_percentile":13733.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":60240.86,"10th_percentile":60240.86,"90th_percentile":60240.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13635.38,"10th_percentile":13635.38,"90th_percentile":13635.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13733.45,"10th_percentile":13733.45,"90th_percentile":13733.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":27152.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10046.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18083.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10046.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20938.2},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21985.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10046.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9945.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21513.55},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15539.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27152.56},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10046.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":15114.81,"10th_percentile":15114.81,"90th_percentile":15114.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13961.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5165.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9298.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5165.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10766.27},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11304.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5165.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5114.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5217.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11062.11},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7990.06},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13961.65},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5165.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":22204.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8215.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7969.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14788.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8215.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17122.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17978.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8215.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8133.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8297.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17592.89},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12707.18},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22204.24},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8215.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9562.12,"10th_percentile":9562.12,"90th_percentile":9562.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13987.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5020.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9315.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10786.31},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11325.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5123.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5227.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11082.69},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8004.93},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13987.63},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5847.52,"10th_percentile":5847.52,"90th_percentile":5847.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2516.32,"10th_percentile":2516.32,"90th_percentile":2516.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6021.27,"10th_percentile":6021.27,"90th_percentile":6021.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":16528.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11007.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12745.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13383.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6054.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6176.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13095.86},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9459.02},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16528.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":12475.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4615.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4477.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8308.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4615.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9620.33},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10101.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4615.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4569.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4662.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9884.68},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7139.61},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12475.6},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4615.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2604.98,"10th_percentile":2604.98,"90th_percentile":2604.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":34115.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12622.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12243.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22720.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12622.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26307.31},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27623.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12622.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12496.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27030.19},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19523.67},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34115.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12622.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":22451.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8057.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14952.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17313.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18179.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8224.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8390.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17789.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12848.93},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22451.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13637.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5045.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4894.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9082.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5045.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10516.51},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11042.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5045.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4995.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5096.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10805.49},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7804.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13637.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5045.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":30595.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10980.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20376.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23593.37},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24773.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11207.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24241.68},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17509.55},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30595.78},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11320.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10132.96,"10th_percentile":10132.96,"90th_percentile":10132.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9930.9,"10th_percentile":9930.9,"90th_percentile":9930.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12539.76,"10th_percentile":12539.76,"90th_percentile":12539.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":17804.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6587.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6390.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11858.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6587.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13729.97},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14416.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6587.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6521.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14107.24},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10189.54},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17804.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6587.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22950.0,"10th_percentile":22950.0,"90th_percentile":22950.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5898.45,"10th_percentile":5898.45,"90th_percentile":5898.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6947.88,"10th_percentile":6947.88,"90th_percentile":6947.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13069.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4835.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4690.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8704.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4835.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10078.44},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10582.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4835.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4884.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10355.38},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7479.6},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13069.67},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4835.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":42983.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15903.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15426.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28626.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15903.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":33145.59},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34803.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15903.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16062.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34056.37},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":24598.61},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":42983.04},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15903.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":19976.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7391.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7169.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13304.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7391.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15404.81},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16175.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7391.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7317.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15828.11},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11432.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19976.89},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7391.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15300.0,"10th_percentile":15300.0,"90th_percentile":15300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":14482.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5358.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5197.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9645.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5358.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11168.29},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11726.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5358.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5305.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5412.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11475.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8288.41},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14482.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5358.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":33443.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12373.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12002.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22273.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12373.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25789.1},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27078.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12373.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12250.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26497.74},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19139.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33443.19},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12373.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":20908.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13925.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16123.36},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16929.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7658.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16566.41},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11965.77},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20908.7},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15139.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5601.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5433.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10082.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5601.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11674.48},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12258.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5601.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5545.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11995.27},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8664.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15139.41},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5601.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":29030.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10741.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10418.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19333.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10741.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22385.99},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23505.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10741.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10633.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23001.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16613.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29030.05},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10741.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9213.98,"10th_percentile":9213.98,"90th_percentile":9213.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60984.0,"10th_percentile":60984.0,"90th_percentile":60984.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17838.17,"10th_percentile":17838.17,"90th_percentile":17838.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10625.6,"10th_percentile":10625.6,"90th_percentile":10625.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7126.4,"10th_percentile":7126.4,"90th_percentile":7126.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80.0,"10th_percentile":80.0,"90th_percentile":80.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10914.25,"10th_percentile":10914.25,"90th_percentile":10914.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":16649.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6160.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5975.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11088.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6160.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12839.12},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13481.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6160.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6098.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6221.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13191.92},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9528.41},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16649.72},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6160.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1786.9,"10th_percentile":1786.9,"90th_percentile":1832.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6734.11,"10th_percentile":5923.49,"90th_percentile":6859.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7307.3,"10th_percentile":7307.3,"90th_percentile":7307.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6930.44,"10th_percentile":6930.44,"90th_percentile":6930.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":22451.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8057.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14952.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17313.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18179.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8224.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8390.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17789.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12848.93},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22451.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":15292.97,"10th_percentile":15292.97,"90th_percentile":15292.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":14377.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5319.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5160.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9575.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5319.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11086.82},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11641.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5319.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5266.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5372.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11391.46},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8227.95},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14377.33},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5319.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6232.71,"10th_percentile":6232.71,"90th_percentile":6232.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6102.2,"10th_percentile":6102.2,"90th_percentile":6102.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4467.71,"10th_percentile":4467.71,"90th_percentile":4467.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5570.52,"10th_percentile":5570.52,"90th_percentile":5570.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":22893.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8470.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8216.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15247.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8470.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17653.96},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18536.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8470.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18139.06},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13101.68},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22893.58},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8470.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33890.0,"10th_percentile":33890.0,"90th_percentile":33890.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":14385.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5322.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5163.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9581.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5322.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11093.49},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11648.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5322.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5269.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5376.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11398.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8232.91},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14385.99},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5322.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":824.44,"10th_percentile":824.44,"90th_percentile":824.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":25753.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9528.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9242.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17151.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9528.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19859.04},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20852.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9528.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9433.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9623.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20404.73},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14738.15},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25753.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9528.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10142.0,"10th_percentile":10142.0,"90th_percentile":10142.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10309.44,"10th_percentile":10309.44,"90th_percentile":10309.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7183.13,"10th_percentile":7183.13,"90th_percentile":7183.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15470.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5723.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5552.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10303.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5723.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11929.58},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12526.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5723.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5666.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5781.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12257.38},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8853.4},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15470.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5723.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12267.0,"10th_percentile":12267.0,"90th_percentile":12267.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6271.12,"10th_percentile":6271.12,"90th_percentile":6271.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5468.6,"10th_percentile":5468.6,"90th_percentile":5468.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":32300.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21511.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24907.6},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26153.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11831.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12070.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25592.02},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18484.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":32300.07},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11951.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":19504.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7216.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7000.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12989.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7216.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15040.19},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15792.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7216.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7144.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7288.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15453.47},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11161.9},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19504.05},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7216.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5947.5,"10th_percentile":5947.5,"90th_percentile":5947.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13923.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4997.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9273.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10736.89},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11273.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5203.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11031.92},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7968.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13923.55},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4667.08,"10th_percentile":4667.08,"90th_percentile":4667.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4241.23,"10th_percentile":4241.23,"90th_percentile":4241.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":24677.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8856.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16435.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19029.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19981.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9039.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19552.53},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14122.62},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24677.54},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9633.24,"10th_percentile":9633.24,"90th_percentile":9633.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9843.68,"10th_percentile":9843.68,"90th_percentile":9843.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8899.17,"10th_percentile":8899.17,"90th_percentile":8899.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":15510.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5738.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10329.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5738.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11960.3},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12558.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5738.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5681.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5796.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12288.95},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8876.2},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15510.06},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5738.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":768.93,"10th_percentile":768.93,"90th_percentile":768.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5732.02,"10th_percentile":5732.02,"90th_percentile":5732.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6647.08,"10th_percentile":6647.08,"90th_percentile":6647.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2331.51,"10th_percentile":2331.51,"90th_percentile":2331.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6551.77,"10th_percentile":6551.77,"90th_percentile":6551.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":26735.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9891.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9595.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17805.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9891.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20616.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21647.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9891.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9793.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9990.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21182.82},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15300.16},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26735.15},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9891.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23084.2,"10th_percentile":23084.2,"90th_percentile":23084.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10231.35,"10th_percentile":10231.35,"90th_percentile":10231.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9311.79,"10th_percentile":9311.79,"90th_percentile":9311.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10504.22,"10th_percentile":10504.22,"90th_percentile":10504.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7942.53,"10th_percentile":7942.53,"90th_percentile":7942.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":16876.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11239.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13014.09},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13664.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6181.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6306.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13371.69},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9658.25},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16876.61},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6244.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13281.0,"10th_percentile":13281.0,"90th_percentile":13281.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7352.78,"10th_percentile":7352.78,"90th_percentile":7352.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":12977.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4801.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4657.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8643.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4801.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10007.65},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10508.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4801.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4753.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4849.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10282.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7427.06},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12977.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4801.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":50939.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18847.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18282.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33925.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18847.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":39281.33},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41245.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18847.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18659.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19036.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40360.72},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":29152.18},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":50939.85},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18847.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20051.59,"10th_percentile":20051.59,"90th_percentile":20051.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19073.48,"10th_percentile":19073.48,"90th_percentile":19073.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":29262.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10826.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10502.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19488.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10826.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22564.96},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23693.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10826.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10718.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10935.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23185.01},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16746.32},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29262.14},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10826.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9123.98,"10th_percentile":9123.98,"90th_percentile":9123.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10350.86,"10th_percentile":10350.86,"90th_percentile":10350.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":16595.66,"10th_percentile":16595.66,"90th_percentile":16595.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":19853.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7345.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7125.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13222.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7345.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15309.98},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16075.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7345.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7272.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7419.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15730.67},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11362.13},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19853.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7345.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12492.0,"10th_percentile":12492.0,"90th_percentile":12492.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":15677.16,"10th_percentile":15677.16,"90th_percentile":15677.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":113470.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41983.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40724.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75571.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41983.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":87500.5},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":91876.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41983.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41564.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42403.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89904.86},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":64937.48},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":113470.25},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41983.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":60124.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22246.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21578.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40042.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22246.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":46364.02},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48682.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22246.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22023.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22468.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47638.02},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":34408.52},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":60124.65},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22246.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":31124.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11515.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11170.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20728.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11515.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24000.73},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25201.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11515.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11400.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11631.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24660.23},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17811.86},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31124.04},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11515.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":84888.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31408.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30466.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56535.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31408.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":65460.43},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":68734.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31408.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31094.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31722.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67259.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":48580.69},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":84888.78},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31408.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":45910.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16986.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16477.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30576.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16986.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":35402.75},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37173.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16986.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16816.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17156.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36375.56},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":26273.74},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":45910.12},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16986.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":27822.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10294.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18529.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10294.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21455.08},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22528.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10294.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10191.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10397.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22044.63},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15922.64},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27822.85},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10294.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":56090.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20753.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20130.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37356.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20753.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":43253.41},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45416.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20753.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20546.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20961.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44441.94},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":32100.01},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":56090.82},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20753.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":32307.17,"10th_percentile":32307.17,"90th_percentile":32307.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16612.09,"10th_percentile":16612.09,"90th_percentile":16612.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":29928.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10741.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19932.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23079.17},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24233.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10962.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11184.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23713.34},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17127.94},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29928.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20795.81,"10th_percentile":20795.81,"90th_percentile":33356.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11406.57,"10th_percentile":11406.57,"90th_percentile":11406.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22857.2,"10th_percentile":22857.2,"90th_percentile":22857.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11763.67,"10th_percentile":11763.67,"90th_percentile":11763.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":24994.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16646.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19274.04},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20238.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9155.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9340.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19803.66},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14304.01},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24994.49},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7623.0,"10th_percentile":7623.0,"90th_percentile":15245.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9469.73,"10th_percentile":9469.73,"90th_percentile":9469.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":12662.98,"10th_percentile":12662.98,"90th_percentile":12662.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":33368.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12346.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11976.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22223.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12346.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25731.67},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27018.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12346.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12222.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12469.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26438.73},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19096.46},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33368.71},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12346.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10719.11,"maximum":29866.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11050.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10719.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19891.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11050.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23031.09},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24182.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11050.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10940.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23663.94},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17092.25},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29866.61},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11050.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":37076.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13306.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24693.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28591.19},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30021.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13581.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13855.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29376.83},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21218.62},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":37076.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":33412.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11991.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22252.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25765.06},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27053.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12238.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26473.04},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19121.24},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33412.01},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1125.0,"10th_percentile":1125.0,"90th_percentile":1125.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":33519.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12402.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22323.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12402.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25847.87},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27140.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12402.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12278.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12526.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26558.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19182.69},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33519.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12402.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13425.51,"10th_percentile":13425.51,"90th_percentile":13425.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":20546.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7602.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13684.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7602.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15844.22},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16636.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7602.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7526.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7678.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16279.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11758.61},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20546.72},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7602.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":15012.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5554.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5388.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9998.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5554.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11576.98},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12156.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5554.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5499.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5610.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11895.1},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8591.72},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15012.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5554.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":36730.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13590.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13182.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24462.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13590.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28324.07},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29740.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13590.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13454.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13726.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29102.37},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21020.38},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36730.52},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13590.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":18748.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6937.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6728.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12486.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6937.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14457.87},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15180.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6937.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6867.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7006.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14855.15},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10729.74},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18748.9},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6937.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2350.32,"10th_percentile":2350.32,"90th_percentile":2350.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":28874.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10683.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10362.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19230.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10683.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22265.79},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23379.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10683.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10576.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10790.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22877.61},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16524.3},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28874.17},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10683.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":19594.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7249.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7032.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13049.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7249.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15109.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15865.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7249.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7177.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7322.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15524.83},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11213.45},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19594.12},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7249.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13326.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4930.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4782.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8875.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4930.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10276.11},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10790.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4930.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4881.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4979.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10558.48},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7626.29},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13326.01},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4930.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":18040.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6674.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6474.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12014.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6674.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13911.61},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14607.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6674.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6608.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6741.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14293.88},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10324.34},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18040.51},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6674.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":10478.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3877.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3760.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6978.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3877.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8080.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8484.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3877.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3838.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3915.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8302.42},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":5996.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":10478.6},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3877.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":4835.84,"10th_percentile":4835.84,"90th_percentile":4835.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":24616.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9108.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8835.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16394.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9108.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18982.88},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19932.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9108.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9017.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9199.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19504.5},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14087.93},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24616.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9108.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9396.21,"10th_percentile":9396.21,"90th_percentile":9396.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9719.0,"10th_percentile":9719.0,"90th_percentile":9719.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9637.1,"10th_percentile":9636.93,"90th_percentile":9677.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8332.76,"10th_percentile":8332.76,"90th_percentile":10453.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":22082.26,"10th_percentile":22082.26,"90th_percentile":22082.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9934.98,"10th_percentile":9934.98,"90th_percentile":9934.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15083.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5581.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5413.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10045.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5581.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11631.74},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12213.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5581.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5525.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5636.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11951.36},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8632.36},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15083.99},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5581.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":3916.56,"10th_percentile":3916.56,"90th_percentile":3916.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":9867.0,"10th_percentile":1134.69,"90th_percentile":13756.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6243.64,"10th_percentile":5340.17,"90th_percentile":6272.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6764.58,"10th_percentile":6764.58,"90th_percentile":6764.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":3514.18,"10th_percentile":3514.18,"90th_percentile":3514.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6372.48,"10th_percentile":6372.48,"90th_percentile":6403.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7818.78,"10th_percentile":7818.78,"90th_percentile":7818.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":419.25,"10th_percentile":419.25,"90th_percentile":419.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6474.32,"10th_percentile":6474.32,"90th_percentile":6474.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":25496.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9433.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9150.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16980.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9433.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19661.37},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20644.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9433.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9339.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9528.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20201.63},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14591.46},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25496.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9433.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10534.73,"10th_percentile":10534.73,"90th_percentile":10534.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7446.05,"10th_percentile":7446.05,"90th_percentile":7446.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":15865.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5870.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5693.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10566.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5870.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12234.1},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12845.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5870.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5811.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5928.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12570.27},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9079.39},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15865.12},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5870.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8746.0,"10th_percentile":8746.0,"90th_percentile":13406.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5179.38,"10th_percentile":5179.38,"90th_percentile":6050.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":559.0,"10th_percentile":559.0,"90th_percentile":559.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":26208.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20210.3},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21221.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9794.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20765.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14998.84},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26208.62},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15698.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5808.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5634.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10455.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5808.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12105.88},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12711.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5808.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5750.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5866.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12438.53},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8984.24},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15698.85},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5808.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2964.24,"10th_percentile":2964.24,"90th_percentile":2964.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2344.45,"10th_percentile":2344.45,"90th_percentile":2344.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":37961.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13624.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25282.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29273.68},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30737.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13905.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14186.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30078.07},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21725.12},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":37961.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":24235.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16141.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18689.05},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19623.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9056.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19202.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13869.86},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24235.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8967.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":60401.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22348.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21678.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40227.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22348.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":46577.71},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48907.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22348.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22125.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47857.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":34567.11},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":60401.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22348.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23207.82,"10th_percentile":23207.82,"90th_percentile":23207.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":32393.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11985.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11626.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21574.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11985.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24979.73},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26229.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11985.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11865.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12105.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25666.13},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18538.41},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":32393.6},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11985.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13281.0,"10th_percentile":12806.0,"90th_percentile":13756.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16486.11,"10th_percentile":16486.11,"90th_percentile":16486.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12684.35,"10th_percentile":12124.92,"90th_percentile":13318.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12557.51,"10th_percentile":12557.51,"90th_percentile":12557.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":24564.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9089.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8816.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16360.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9089.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18942.81},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19890.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9089.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8998.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9179.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19463.33},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14058.19},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24564.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9089.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":50009.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18503.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17948.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33306.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18503.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":38564.11},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40492.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18503.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18318.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18688.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39623.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":28619.91},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":50009.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18503.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9947.69,"maximum":27717.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9947.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18459.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21373.61},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22442.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10152.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21960.92},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15862.17},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27717.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9376.43,"maximum":26125.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17399.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20146.19},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21153.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9763.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20699.77},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14951.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26125.49},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":9031.1,"10th_percentile":9031.1,"90th_percentile":9031.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25410.0,"10th_percentile":25410.0,"90th_percentile":25410.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9897.42,"10th_percentile":9897.42,"90th_percentile":9897.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9151.82,"10th_percentile":9151.82,"90th_percentile":9151.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":61645.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22808.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22124.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41055.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22808.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":47536.68},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49914.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22808.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22580.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23036.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48842.9},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35278.79},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":61645.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22808.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":31070.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11496.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11151.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20692.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11496.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23959.33},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25157.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11496.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11610.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24617.69},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17781.14},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31070.35},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11496.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16545.0,"10th_percentile":16545.0,"90th_percentile":16545.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12829.17,"10th_percentile":12829.17,"90th_percentile":12829.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12466.62,"10th_percentile":12466.62,"90th_percentile":12466.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":18959.67,"10th_percentile":18959.67,"90th_percentile":18959.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":21682.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8022.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14440.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8022.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16720.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17556.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8022.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17179.82},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12408.83},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":21682.91},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8022.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":52308.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19353.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18773.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34837.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19353.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":40336.46},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42353.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19353.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19160.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19547.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41444.83},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":29935.23},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":52308.13},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19353.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9320.48,"maximum":25969.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9608.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9320.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17295.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9608.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20025.99},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21027.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9608.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9512.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9704.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20576.27},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14862.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25969.61},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9608.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8463.4,"10th_percentile":8463.4,"90th_percentile":8463.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":23006.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8512.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15322.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8512.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17740.77},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18628.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8512.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8427.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8597.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18228.26},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13166.11},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23006.16},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8512.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7623.0,"10th_percentile":7623.0,"90th_percentile":7623.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":14351.52,"10th_percentile":14351.52,"90th_percentile":14351.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":64548.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23882.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23166.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42989.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23882.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":49775.14},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52264.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23882.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23643.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24121.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51142.88},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":36940.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":64548.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23882.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":37736.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13962.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25132.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13962.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29100.05},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30555.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13962.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13822.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14102.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29899.67},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21596.27},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":37736.82},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13962.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25878.0,"10th_percentile":25878.0,"90th_percentile":25878.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":15703.34,"10th_percentile":15703.34,"90th_percentile":15703.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":19595.0,"10th_percentile":19595.0,"90th_percentile":19595.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14572.07,"10th_percentile":14572.07,"90th_percentile":14572.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9072.46,"maximum":25278.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9072.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16835.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19493.08},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20468.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9259.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9446.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20028.72},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14466.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25278.54},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":24883.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8930.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16572.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19188.57},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20148.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9114.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9299.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19715.83},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14240.57},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24883.64},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9219.0,"10th_percentile":2711.2,"90th_percentile":30501.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8772.16,"10th_percentile":8772.16,"90th_percentile":8772.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18107.39,"10th_percentile":18107.39,"90th_percentile":18107.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9858.52,"10th_percentile":9858.52,"90th_percentile":9858.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19917.99,"10th_percentile":19917.99,"90th_percentile":19917.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9775.83,"10th_percentile":9775.83,"90th_percentile":9775.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":14434.85,"10th_percentile":14434.85,"90th_percentile":14434.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8525.49,"10th_percentile":8525.49,"90th_percentile":8525.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15522.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5570.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10337.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11969.65},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12568.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5685.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5800.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12298.55},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8883.13},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15522.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2351.5,"10th_percentile":2351.5,"90th_percentile":2351.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":6703.0,"10th_percentile":2049.16,"90th_percentile":10167.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5624.91,"10th_percentile":5624.91,"90th_percentile":5624.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":12696.85,"10th_percentile":12696.85,"90th_percentile":12696.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2389.74,"10th_percentile":2389.74,"90th_percentile":2389.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90.0,"10th_percentile":90.0,"90th_percentile":90.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":5204.26,"10th_percentile":5204.26,"90th_percentile":5204.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"11","median_amount":7666.51,"10th_percentile":4614.73,"90th_percentile":9091.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":10759.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3980.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3861.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7165.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3980.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8296.75},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8711.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3980.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3941.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8524.73},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6157.33},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":10759.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3980.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":8809.35,"10th_percentile":8809.35,"90th_percentile":8809.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6278.0,"10th_percentile":228.81,"90th_percentile":12956.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6157.33,"10th_percentile":6157.33,"90th_percentile":6210.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":23132.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8559.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8302.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15406.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8559.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17838.27},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18730.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8559.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8644.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18328.44},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13238.47},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23132.59},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8559.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1448.0,"10th_percentile":1448.0,"90th_percentile":1448.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9250.0,"10th_percentile":7204.0,"90th_percentile":15300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8828.59,"10th_percentile":7685.99,"90th_percentile":8857.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10261.57,"10th_percentile":10261.57,"90th_percentile":10261.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9550.28,"10th_percentile":7369.94,"90th_percentile":9561.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8715.44,"10th_percentile":6816.91,"90th_percentile":9048.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":13238.47,"10th_percentile":13238.47,"90th_percentile":13238.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7258.23,"10th_percentile":7258.23,"90th_percentile":7258.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13478.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4987.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4837.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8976.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4987.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10393.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10913.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4987.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4937.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5036.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10679.24},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7713.52},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13478.42},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4987.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5845.99,"10th_percentile":5845.99,"90th_percentile":5845.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1822.1,"10th_percentile":901.06,"90th_percentile":10200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5670.49,"10th_percentile":2665.66,"90th_percentile":5693.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2642.11,"10th_percentile":2461.55,"90th_percentile":6160.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":11026.34,"10th_percentile":11026.34,"90th_percentile":11026.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":155.0,"10th_percentile":155.0,"90th_percentile":155.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":5584.81,"10th_percentile":5584.81,"90th_percentile":5584.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6438.03,"10th_percentile":4430.4,"90th_percentile":29690.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5845.84,"10th_percentile":4552.23,"90th_percentile":5877.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":24630.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16404.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18993.57},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19943.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9022.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19515.48},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14095.86},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24630.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9113.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":28510.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10548.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10232.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18987.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10548.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21985.31},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23084.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10548.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10443.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22589.43},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16316.14},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28510.45},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10548.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11785.0,"10th_percentile":11785.0,"90th_percentile":11785.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10185.1,"10th_percentile":10185.1,"90th_percentile":10185.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11606.17,"10th_percentile":11606.17,"90th_percentile":11606.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":16427.16,"10th_percentile":16427.16,"90th_percentile":16427.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":17753.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6568.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6371.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11823.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6568.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13689.9},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14374.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6568.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6502.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6634.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14066.08},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10159.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17753.0},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6568.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17507.0,"10th_percentile":17507.0,"90th_percentile":19046.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7711.18,"10th_percentile":7711.18,"90th_percentile":7711.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13306.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4775.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8862.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10261.41},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10774.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4874.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4972.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10543.38},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7615.39},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13306.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4802.22,"10th_percentile":4802.22,"90th_percentile":4802.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":81428.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30128.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29224.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54231.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30128.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":62791.9},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65932.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30128.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29827.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30429.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64517.31},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":46600.28},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":81428.25},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30128.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":64184.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23035.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42746.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":49494.66},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51970.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23510.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23985.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50854.69},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":36731.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":64184.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23748.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":55934.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20695.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20075.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37252.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20695.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":43133.2},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45290.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20695.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20488.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20902.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44318.43},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":32010.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":55934.94},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20695.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":90001.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33300.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32301.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59941.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33300.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":69403.12},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":72874.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33300.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32967.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33633.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71310.2},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":51506.72},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":90001.65},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33300.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":48483.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17939.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17400.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32290.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17939.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":37387.45},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39257.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17939.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17759.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18118.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38414.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":27746.66},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":48483.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17939.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16744.53,"10th_percentile":16744.53,"90th_percentile":16744.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":36659.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13564.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13157.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24415.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13564.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28269.31},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29683.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13564.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13428.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29046.1},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20979.74},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36659.51},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13564.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6278.31,"10th_percentile":6278.31,"90th_percentile":6278.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":55143.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20403.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19790.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36725.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20403.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":42522.83},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44649.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20403.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20199.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20607.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43691.29},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31557.83},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":55143.42},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20403.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20827.94,"10th_percentile":20827.94,"90th_percentile":20827.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":31695.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11727.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11375.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21109.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11727.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24441.48},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25663.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11727.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11610.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11844.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25113.09},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18138.96},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31695.6},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11727.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16403.0,"10th_percentile":16403.0,"90th_percentile":16403.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10568.82,"10th_percentile":10568.82,"90th_percentile":10568.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":26877.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9944.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9646.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17900.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9944.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20725.84},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21762.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9944.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9845.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10043.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21295.35},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15381.44},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26877.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9944.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":44008.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16283.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15794.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29309.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16283.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":33936.26},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35633.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16283.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16120.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16445.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34868.77},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":25185.4},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":44008.39},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16283.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14470.96,"10th_percentile":14470.96,"90th_percentile":14470.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31864.0,"10th_percentile":31864.0,"90th_percentile":39468.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16395.84,"10th_percentile":15758.27,"90th_percentile":16507.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17417.69,"10th_percentile":17417.69,"90th_percentile":17417.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16902.69,"10th_percentile":16902.69,"90th_percentile":16902.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":22891.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8469.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8215.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15245.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8469.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17652.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18535.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8469.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8554.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18137.69},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13100.69},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22891.84},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8469.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":13846.0,"10th_percentile":3654.93,"90th_percentile":59484.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7084.47,"10th_percentile":7084.47,"90th_percentile":8100.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15821.67,"10th_percentile":15821.67,"90th_percentile":15821.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9625.18,"10th_percentile":9625.18,"90th_percentile":9750.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":12883.96,"10th_percentile":12883.96,"90th_percentile":12883.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6436.19,"maximum":17933.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6436.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11943.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13828.8},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14520.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6568.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6701.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14208.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10262.88},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17933.13},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":4991.95,"10th_percentile":2814.67,"90th_percentile":15021.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4319.47,"10th_percentile":4319.47,"90th_percentile":4319.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7242.34,"10th_percentile":7242.34,"90th_percentile":7242.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":12072.82,"10th_percentile":12072.82,"90th_percentile":12072.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":1377.76,"10th_percentile":1377.76,"90th_percentile":1377.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4504.0,"10th_percentile":4504.0,"90th_percentile":4504.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":53025.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19619.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19030.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35314.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19619.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":40889.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42934.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19619.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19423.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19815.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42012.96},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":30345.59},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":53025.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19619.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9654.14,"10th_percentile":9654.14,"90th_percentile":9654.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":26329.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9742.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9449.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17535.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9742.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20303.79},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21319.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9742.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20861.7},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15068.22},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26329.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9742.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9101.6,"10th_percentile":9101.6,"90th_percentile":9101.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6507.67,"maximum":18132.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6507.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12076.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13982.4},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14681.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6641.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6776.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14366.61},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10376.87},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18132.31},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":54059.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20001.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19401.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36003.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20001.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":41686.75},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43771.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20001.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19801.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20201.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42832.23},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":30937.33},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":54059.18},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20001.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":30297.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10873.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20178.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23363.65},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24532.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11098.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11322.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24005.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17339.06},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30297.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10827.06,"10th_percentile":10827.06,"90th_percentile":10827.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":19159.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6876.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14774.41},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15513.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7018.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7159.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15180.38},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10964.65},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19159.38},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":50574.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18712.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18151.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33682.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18712.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":38999.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40950.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18712.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18525.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18899.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40071.16},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":28943.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":50574.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18712.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":33570.19,"10th_percentile":33570.19,"90th_percentile":33570.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16521.54,"10th_percentile":16521.54,"90th_percentile":16521.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":26880.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9945.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9647.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17902.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9945.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20728.51},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21765.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9945.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9846.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10045.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21298.1},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15383.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26880.64},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9945.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7819.0,"10th_percentile":7819.0,"90th_percentile":7819.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10106.11,"10th_percentile":10106.11,"90th_percentile":10106.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10437.93,"10th_percentile":10437.93,"90th_percentile":10437.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6075.03,"maximum":16926.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6262.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6075.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11273.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6262.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13052.82},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13705.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6262.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6200.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6325.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13411.49},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9687.0},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16926.84},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6262.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":31089.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20705.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23974.02},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25173.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11388.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11618.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24632.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17792.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31089.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11503.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13281.0,"10th_percentile":13281.0,"90th_percentile":13281.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":18696.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6917.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6710.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12452.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6917.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14417.8},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15138.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6917.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6848.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6987.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14813.98},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10700.0},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18696.94},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6917.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":72771.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26925.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26117.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48465.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26925.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":56116.57},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58923.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26925.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26656.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27194.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57658.56},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":41646.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":72771.71},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26925.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":396656.0,"10th_percentile":396656.0,"90th_percentile":396656.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25343.38,"10th_percentile":25343.38,"90th_percentile":25343.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23937.16,"10th_percentile":23937.16,"90th_percentile":23937.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6752.55,"10th_percentile":6752.55,"90th_percentile":6752.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":40504.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14986.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14537.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26975.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14986.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":31234.34},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32796.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14986.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14836.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15136.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32092.61},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23180.2},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":40504.55},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14986.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16945.0,"10th_percentile":16945.0,"90th_percentile":19559.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":310.0,"10th_percentile":310.0,"90th_percentile":310.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":31447.96,"10th_percentile":31447.96,"90th_percentile":31447.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":28429.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10518.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10203.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18933.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10518.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21922.54},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23018.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10518.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10413.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10623.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22524.93},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16269.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28429.05},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10518.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":25650.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9490.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17083.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9490.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19780.24},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20769.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9490.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9395.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9585.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20323.76},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14679.67},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25650.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9490.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11623.73,"10th_percentile":11623.73,"90th_percentile":11623.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8984.27,"10th_percentile":8236.3,"90th_percentile":9837.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9802.14,"10th_percentile":9607.56,"90th_percentile":10635.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":17489.4,"10th_percentile":17489.4,"90th_percentile":17489.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10129.39,"10th_percentile":10129.39,"90th_percentile":10129.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10292.11,"10th_percentile":10292.11,"90th_percentile":10292.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":14886.83,"10th_percentile":14886.83,"90th_percentile":48910.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8957.73,"10th_percentile":8291.89,"90th_percentile":10159.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":15168.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5612.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5444.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10102.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5612.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11697.18},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12282.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5612.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5556.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5668.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12018.6},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8680.93},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15168.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5612.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6517.99,"10th_percentile":5137.39,"90th_percentile":6524.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":14020.41,"10th_percentile":14020.41,"90th_percentile":14020.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":5550.0,"10th_percentile":2350.0,"90th_percentile":12053.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6307.74,"10th_percentile":6021.94,"90th_percentile":6418.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5573.72,"10th_percentile":5064.73,"90th_percentile":6809.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5538.04,"10th_percentile":3770.79,"90th_percentile":6446.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6043.98,"10th_percentile":6043.98,"90th_percentile":6043.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7153.9,"10th_percentile":7153.9,"90th_percentile":8140.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6485.09,"10th_percentile":6485.09,"90th_percentile":6500.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":10397.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3846.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3731.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6924.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3846.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8017.61},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8418.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3846.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3808.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3885.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8237.92},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":5950.17},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":10397.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3846.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5100.0,"10th_percentile":5100.0,"90th_percentile":5100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4448.54,"10th_percentile":4448.54,"90th_percentile":4682.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":4552.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":31240.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20805.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24090.22},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25295.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11443.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11674.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24752.18},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17878.27},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31240.08},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11558.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12079.48,"10th_percentile":12079.48,"90th_percentile":12079.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18147.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6513.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12086.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13994.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14694.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6781.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14378.96},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10385.79},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18147.9},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6714.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3709.41,"10th_percentile":3709.41,"90th_percentile":3709.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13688.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5064.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4912.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9116.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5064.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10555.25},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11083.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5064.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5013.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5115.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10845.29},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7833.45},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13688.0},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5064.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":20096.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7435.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13384.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7435.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15496.97},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16272.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7435.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7361.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7510.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15922.8},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11500.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20096.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7435.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6290.0,"10th_percentile":6290.0,"90th_percentile":6290.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":7359.59,"10th_percentile":6492.41,"90th_percentile":7948.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8170.56,"10th_percentile":6610.72,"90th_percentile":8565.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8120.18,"10th_percentile":8120.18,"90th_percentile":8120.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6158.01,"10th_percentile":6158.01,"90th_percentile":6158.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8094.08,"10th_percentile":4869.4,"90th_percentile":10214.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":14020.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5187.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5031.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9337.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5187.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10811.68},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11352.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5187.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5239.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11108.77},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8023.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14020.54},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5187.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4031.5,"10th_percentile":4031.5,"90th_percentile":4031.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":9976.34,"10th_percentile":9976.34,"90th_percentile":9976.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6778.0,"10th_percentile":1136.25,"90th_percentile":16945.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2278.06,"10th_percentile":2278.06,"90th_percentile":5960.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4526.1,"10th_percentile":4315.4,"90th_percentile":6314.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":7955.54,"10th_percentile":7955.54,"90th_percentile":7955.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2480.32,"10th_percentile":80.0,"90th_percentile":4638.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":7955.37,"10th_percentile":7080.28,"90th_percentile":13623.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5972.04,"10th_percentile":5972.04,"90th_percentile":5994.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":12705.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":23286.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8616.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8357.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15508.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8616.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17957.14},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18855.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8616.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8529.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8702.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18450.57},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13326.68},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23286.74},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8616.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":13539.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4859.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9016.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10440.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10962.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5009.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4959.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5059.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10727.27},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7748.21},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13539.04},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5009.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4900.9,"10th_percentile":4900.9,"90th_percentile":4900.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1420.31,"10th_percentile":723.63,"90th_percentile":4552.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5808.01,"10th_percentile":5808.01,"90th_percentile":5808.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":430.02,"10th_percentile":430.02,"90th_percentile":430.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":19810.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7110.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13193.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15276.59},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16040.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7256.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7403.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15696.37},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11337.35},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19810.62},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":11933.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4415.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4282.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7947.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4415.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9202.28},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9662.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4415.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4371.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4459.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9455.15},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6829.37},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11933.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4415.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5171.74,"10th_percentile":5171.74,"90th_percentile":5171.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18667.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6906.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6699.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12432.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6906.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14395.1},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15115.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6906.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6837.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6976.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14790.65},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10683.15},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18667.5},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6906.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":10483.44,"10th_percentile":10483.44,"90th_percentile":10483.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":28654.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10602.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10283.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19083.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10602.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22096.17},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23201.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10602.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10708.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22703.33},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16398.41},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28654.21},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10602.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8862.29,"10th_percentile":8862.29,"90th_percentile":8862.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20334.0,"10th_percentile":20334.0,"90th_percentile":40668.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10857.81,"10th_percentile":9562.01,"90th_percentile":10875.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20560.09,"10th_percentile":20560.09,"90th_percentile":20560.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10268.88,"10th_percentile":9471.58,"90th_percentile":11120.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9550.41,"10th_percentile":9550.41,"90th_percentile":10311.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":17579.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6504.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6309.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11708.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6504.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13556.34},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14234.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6504.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6439.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6569.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13928.85},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10060.68},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17579.8},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6504.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":27366.61,"10th_percentile":27366.61,"90th_percentile":27366.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7057.42,"10th_percentile":7057.42,"90th_percentile":7057.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7230.22,"10th_percentile":7230.22,"90th_percentile":7230.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":4037.0,"10th_percentile":4037.0,"90th_percentile":4037.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7263.72,"10th_percentile":7263.72,"90th_percentile":7263.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":11949.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4288.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7958.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9214.3},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9675.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4376.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4465.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9467.5},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6838.29},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11949.07},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":1315.5,"10th_percentile":1315.5,"90th_percentile":1315.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12434.14,"maximum":34645.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12818.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12434.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23073.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12818.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26716.01},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28052.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12818.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12690.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12946.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27450.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19826.97},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34645.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12818.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12947.32,"10th_percentile":12947.32,"90th_percentile":12947.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9536.80,"maximum":26572.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9536.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17697.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20490.78},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21515.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9733.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9930.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21053.83},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15206.99},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26572.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9831.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12705.0,"10th_percentile":12705.0,"90th_percentile":12705.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9719.43,"10th_percentile":9719.43,"90th_percentile":9719.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":40305.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14465.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26843.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":31080.75},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32635.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14763.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15062.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31934.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23066.22},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":40305.37},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14912.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8710.06,"maximum":24268.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16162.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18714.43},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19650.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8889.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9069.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19228.67},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13888.69},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24268.78},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":36091.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13353.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12953.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24036.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13353.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27831.23},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29223.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13353.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13487.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28595.99},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20654.63},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36091.42},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13353.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":19046.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7047.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6835.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12685.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7047.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14687.59},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15422.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7047.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6976.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7117.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15091.18},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10900.23},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19046.8},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7047.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":26038.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9634.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9345.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17341.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9634.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20079.41},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21083.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9634.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9538.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9730.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20631.16},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14901.7},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26038.89},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9634.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9503.13,"10th_percentile":9503.13,"90th_percentile":9503.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9704.97,"10th_percentile":9704.97,"90th_percentile":9704.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6572.94,"maximum":18314.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6776.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6572.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12197.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6776.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14122.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14828.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6776.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6843.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14510.7},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10480.95},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18314.17},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6776.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":4588.6,"10th_percentile":4588.6,"90th_percentile":4588.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":38750.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13907.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25807.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29881.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31375.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14480.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30702.47},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":22176.12},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":38750.04},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14337.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":25477.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9426.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9143.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16968.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9426.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19646.68},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20629.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9426.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9521.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20186.53},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14580.55},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25477.72},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9426.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":32743.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11751.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21807.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25249.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26512.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11993.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12236.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25943.33},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18738.64},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":32743.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12115.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30614.0,"10th_percentile":30614.0,"90th_percentile":30614.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11947.98,"10th_percentile":11947.98,"90th_percentile":11947.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11654.35,"10th_percentile":11654.35,"90th_percentile":11654.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12142.08,"10th_percentile":12142.08,"90th_percentile":12142.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":23262.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8348.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15492.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17938.44},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18835.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8521.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8693.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18431.36},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13312.81},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23262.49},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22760.0,"10th_percentile":22760.0,"90th_percentile":22760.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8272.07,"10th_percentile":8272.07,"90th_percentile":8272.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":31344.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11597.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11249.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20875.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11597.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24170.35},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25379.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11597.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11481.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24834.51},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17937.75},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31344.0},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11597.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11175.21,"10th_percentile":11175.21,"90th_percentile":11175.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":19791.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7322.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7103.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13181.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7322.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15261.9},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16025.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7322.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7249.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7396.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15681.27},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11326.44},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19791.56},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7322.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1152.03,"10th_percentile":1152.03,"90th_percentile":1152.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":11356.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4201.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7563.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4201.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8757.53},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9195.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4201.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4159.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4244.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8998.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6499.3},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11356.72},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4201.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":20267.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7499.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7274.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13498.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7499.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15629.19},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16410.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7499.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7574.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16058.65},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11599.02},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20267.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7499.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":12505.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4626.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4488.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4626.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9643.03},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10125.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4626.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4580.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4673.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9908.01},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7156.46},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12505.04},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4626.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":25683.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9503.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9217.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17105.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9503.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19805.61},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20796.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9503.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9407.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9598.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20349.84},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14698.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25683.83},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9503.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":14049.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5198.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5042.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9357.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5198.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10834.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11376.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5198.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5146.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11132.1},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8040.61},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14049.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5198.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13556.0,"10th_percentile":13556.0,"90th_percentile":13556.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18336.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6784.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6581.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12212.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6784.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14140.0},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14847.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6784.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6716.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6852.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14528.54},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10493.83},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18336.68},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6784.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7903.51,"10th_percentile":7903.51,"90th_percentile":7903.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":11639.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4177.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7751.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8975.23},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9424.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4263.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4349.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9221.86},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6660.86},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11639.04},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4306.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":36891.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13240.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24569.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28448.28},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29871.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13513.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13786.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29229.99},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21112.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36891.6},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8363.82,"maximum":23304.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8622.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15520.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8622.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17970.5},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18869.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8622.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18464.3},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13336.6},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23304.06},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8622.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":61910.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22906.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22219.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41232.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22906.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":47741.02},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50128.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22906.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22677.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23135.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49052.86},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35430.44},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":61910.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22906.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":35689.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13205.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12808.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23769.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13205.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27521.37},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28897.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13205.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13073.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13337.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28277.61},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20424.67},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":35689.59},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13205.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":25434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9128.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16939.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19613.29},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20594.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9316.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9504.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20152.23},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14555.77},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25434.42},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":62054.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22959.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22271.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41327.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22959.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":47851.88},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50245.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22959.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22730.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23189.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49166.76},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35512.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":62054.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22959.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":31342.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11248.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20873.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24169.02},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25377.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11480.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24833.14},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17936.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31342.27},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11596.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8864.84,"maximum":24700.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9139.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8864.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16450.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9139.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19046.99},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19999.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9139.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9047.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9230.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19570.37},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14135.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24700.05},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9139.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":31778.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11758.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11405.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21164.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11758.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24505.59},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25731.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11758.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11640.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11875.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25178.96},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18186.54},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31778.74},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11758.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":21488.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7950.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7950.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16570.79},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17399.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7950.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8030.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17026.13},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12297.82},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":21488.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7950.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":35490.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12737.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23636.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27367.78},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28736.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13000.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13262.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28119.8},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20310.68},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":35490.41},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13131.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":19701.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7070.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13121.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15192.45},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15952.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7216.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7362.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15609.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11274.9},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19701.5},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":30086.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10798.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20037.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23200.71},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24361.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23838.22},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17218.14},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30086.57},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11132.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5344.01,"maximum":14890.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5509.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5344.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9916.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5509.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11482.15},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12056.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5509.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5454.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5564.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11797.66},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8521.35},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14890.0},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5509.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8623.65,"maximum":24028.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8890.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16002.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8890.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18528.78},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19455.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8890.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8801.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19037.92},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13750.92},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24028.04},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8890.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":44470.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16454.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15960.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29617.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16454.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":34292.87},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36008.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16454.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16289.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16618.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35235.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":25450.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":44470.83},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16454.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":25560.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9173.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17023.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19710.78},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20696.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9362.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9552.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20252.4},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14628.13},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25560.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9457.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":31898.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11802.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11448.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21244.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11802.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24597.75},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25828.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11802.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11684.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11920.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25273.65},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18254.93},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31898.24},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11802.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":120.0,"10th_percentile":120.0,"90th_percentile":120.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":18840.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6971.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6761.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12547.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6971.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14528.66},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15255.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6971.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6901.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7040.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14927.88},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10782.27},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18840.7},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6971.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7566.23,"10th_percentile":7566.23,"90th_percentile":7566.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":16635.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6155.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5970.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11079.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6155.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12828.44},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13470.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6155.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6093.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6216.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13180.94},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9520.48},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16635.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6155.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":24800.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8900.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16517.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19124.46},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20080.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9084.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9267.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19649.96},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14192.99},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24800.51},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":16956.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6273.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6085.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11292.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6273.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13075.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13729.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6273.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6211.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13434.82},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9703.85},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16956.28},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6273.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":11493.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4252.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4125.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7654.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4252.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8863.04},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9306.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4252.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4210.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4295.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9106.58},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6577.6},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11493.55},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4252.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":17449.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6456.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6262.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11621.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6456.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13456.17},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14129.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6456.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6521.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13825.92},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9986.34},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17449.9},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6456.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":9881.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3655.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3546.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6580.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3655.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":7619.6},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8000.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3655.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3619.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3692.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7828.97},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":5654.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":9881.06},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3655.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":3389.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":2550.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":3389.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":18560.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6867.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6661.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12361.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6867.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14312.29},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15028.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6867.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6798.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6935.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14705.57},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10621.7},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18560.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6867.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":29267.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10828.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10504.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19492.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10828.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22568.97},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23697.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10828.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10720.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10937.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23189.13},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16749.3},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29267.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10828.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9104.0,"10th_percentile":9104.0,"90th_percentile":9104.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":17366.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6425.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6232.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11566.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6425.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13392.06},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14061.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6425.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6361.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6489.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13760.05},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9938.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17366.76},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6425.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":3389.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":2550.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":11339.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4069.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7552.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8744.17},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9181.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4237.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8984.45},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6489.39},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11339.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":7623.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":2550.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":14571.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5391.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5229.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9704.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5391.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11236.4},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11798.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5391.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5337.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5445.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11545.16},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8338.97},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14571.32},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5391.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":2550.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":2550.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":2550.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":42522.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15733.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15261.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28319.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15733.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":32790.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34430.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15733.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15575.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15890.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33691.34},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":24334.95},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":42522.33},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15733.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18360.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6793.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6589.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12228.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6793.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14158.7},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14866.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6793.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6725.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6861.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14547.75},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10507.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18360.93},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6793.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":16589.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6137.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5953.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11048.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6137.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12792.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13432.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6137.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6076.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13143.89},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9493.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16589.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6137.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":28569.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10570.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10253.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19027.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10570.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22030.72},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23132.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10570.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10676.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22636.09},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16349.84},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28569.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10570.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":19342.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6942.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12882.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14915.98},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15662.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7085.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7228.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15325.85},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11069.72},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19342.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":16606.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6144.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5960.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11059.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6144.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12805.73},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13446.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6144.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13157.61},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9503.63},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16606.42},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6144.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":31214.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11549.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11202.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20788.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11549.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24070.18},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25274.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11549.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11664.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24731.59},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17863.41},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31214.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11549.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":102941.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38088.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36945.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68558.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38088.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":79381.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":83351.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38088.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37707.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38469.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81562.65},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":58911.97},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":102941.42},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38088.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":70301.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26011.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25231.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46820.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26011.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":54212.0},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56923.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26011.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25751.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26271.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55701.66},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":40232.81},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":70301.88},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26011.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":42420.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15695.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15224.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28251.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15695.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":32711.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34347.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15695.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15538.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33610.37},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":24276.47},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":42420.14},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15695.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":72217.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26720.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25918.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48096.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26720.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":55689.18},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58474.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26720.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26453.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26987.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57219.42},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":41329.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":72217.47},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26720.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":25562.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9458.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17024.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9458.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19712.12},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20698.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9458.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9363.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9552.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20253.78},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14629.12},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25562.59},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9458.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1241.99,"maximum":3460.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1280.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1241.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2304.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1280.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":2668.53},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":2802.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1280.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1267.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1293.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":2741.86},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":1980.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":3460.54},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1280.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":20212.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7478.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7254.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13461.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7478.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15586.45},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16366.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7478.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7403.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7553.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16014.74},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11567.3},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20212.44},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7478.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":17326.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6218.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11539.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13361.34},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14029.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6346.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6475.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13728.49},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9915.96},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17326.93},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":16576.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6133.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5949.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11040.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6133.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12783.03},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13422.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6133.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6072.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6194.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13134.28},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9486.78},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16576.97},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6133.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":78440.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29022.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28152.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52241.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29022.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":60487.99},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63513.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29022.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28732.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29313.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62150.09},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":44890.46},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":78440.55},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29022.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":48658.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18003.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17463.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32406.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18003.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":37522.35},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39399.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18003.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17823.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18183.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38553.4},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":27846.77},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":48658.81},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18003.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":33062.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12232.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11865.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22019.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12232.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25495.27},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26770.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12232.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12355.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26195.83},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18921.02},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33062.15},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12232.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":69004.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25531.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24765.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45957.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25531.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":53211.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55873.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25531.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25276.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25786.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54673.8},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":39490.4},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":69004.61},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25531.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":32196.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11912.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11555.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21442.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11912.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24827.47},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26069.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11912.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11793.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25509.68},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18425.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":32196.15},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11912.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":23485.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8429.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15641.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18110.74},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19016.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18608.39},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13440.67},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23485.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18691.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6915.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6708.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12448.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6915.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14413.8},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15134.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6915.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6846.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6985.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14809.86},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10697.03},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18691.74},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6915.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":13059.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4831.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4686.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8697.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4831.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10070.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10574.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4831.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4783.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4880.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10347.14},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7473.65},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13059.28},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4831.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":11677.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4320.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4190.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4320.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9004.62},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9454.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4320.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4277.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4363.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9252.05},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6682.67},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11677.14},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4320.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":38240.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14149.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13724.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25468.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14149.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29488.71},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30963.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14149.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14290.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30299.01},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21884.7},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":38240.83},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14149.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14849.71,"10th_percentile":14849.71,"90th_percentile":14849.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":89721.0,"10th_percentile":89721.0,"90th_percentile":89721.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14612.64,"10th_percentile":14372.43,"90th_percentile":54211.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14081.69,"10th_percentile":14081.69,"90th_percentile":14081.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":21925.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7869.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14602.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16907.36},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17752.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8031.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17371.95},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12547.6},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":21925.39},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8112.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8306.48,"10th_percentile":8306.48,"90th_percentile":8306.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8991.72,"10th_percentile":8991.72,"90th_percentile":8991.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":18127.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12072.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13978.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14677.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6639.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6774.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14362.49},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10373.9},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18127.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":778.89,"10th_percentile":778.89,"90th_percentile":778.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":24322.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8999.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8729.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16198.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8999.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18755.83},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19693.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8999.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8909.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9089.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19271.21},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13919.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24322.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8999.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7411.58,"10th_percentile":7411.58,"90th_percentile":7411.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7650.0,"10th_percentile":5037.62,"90th_percentile":12505.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9288.31,"10th_percentile":9288.31,"90th_percentile":9288.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9564.81,"10th_percentile":9307.8,"90th_percentile":10042.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80.0,"10th_percentile":80.0,"90th_percentile":80.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":10221.1,"10th_percentile":10221.1,"90th_percentile":10221.1},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9527.07,"10th_percentile":6681.32,"90th_percentile":9611.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15903.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5884.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10591.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5884.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12263.48},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12876.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5884.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5825.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12600.46},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9101.2},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15903.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5884.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8671.39,"10th_percentile":1043.68,"90th_percentile":12861.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5633.82,"10th_percentile":5065.66,"90th_percentile":5918.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7021.4,"10th_percentile":5134.9,"90th_percentile":75669.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2114.74,"10th_percentile":2114.74,"90th_percentile":2114.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5121.42,"10th_percentile":5121.42,"90th_percentile":5121.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":9101.2,"10th_percentile":9101.2,"90th_percentile":9147.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6687.26,"10th_percentile":6687.26,"90th_percentile":8937.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":26418.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9481.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17594.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20371.91},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21390.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9676.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9872.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20931.69},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15118.77},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26418.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10133.14,"10th_percentile":10133.14,"90th_percentile":10340.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10325.44,"10th_percentile":10325.44,"90th_percentile":10325.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9954.89,"10th_percentile":9954.89,"90th_percentile":9954.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":36834.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13219.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24531.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28404.21},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29824.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13765.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29184.7},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21079.85},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36834.44},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":28993.27,"10th_percentile":28993.27,"90th_percentile":28993.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":17562.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6498.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6303.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11696.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6498.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13542.98},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14220.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6498.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6433.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13915.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10050.77},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17562.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6498.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":10946.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4050.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3928.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7290.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4050.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8440.99},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8863.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4050.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4090.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8672.94},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6264.38},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":10946.24},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4050.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":39517.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14621.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14182.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26318.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14621.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":30473.05},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31997.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14621.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14767.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31310.4},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":22615.22},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":39517.31},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14621.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7205.75,"maximum":20077.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7428.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13371.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7428.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15482.28},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16256.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7428.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7354.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15907.7},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11489.99},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20077.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7428.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5345.26,"maximum":14893.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5510.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5345.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9919.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5510.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11484.82},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12059.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5510.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5455.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5565.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11800.41},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8523.33},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14893.47},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5510.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":101578.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37583.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36456.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67651.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37583.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":78330.27},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":82247.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37583.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37208.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37959.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80482.65},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":58131.9},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":101578.34},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37583.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":38772.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14345.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13915.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25822.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14345.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29898.74},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31394.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14345.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14202.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14489.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30720.31},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":22189.0},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":38772.55},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14345.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7484.23,"maximum":20853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7484.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13888.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16080.62},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16884.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7715.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7792.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16522.49},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11934.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20853.28},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7715.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":79408.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29381.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28499.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52886.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29381.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":61234.59},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64297.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29381.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29087.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29675.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62917.21},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":45444.54},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":79408.74},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29381.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":39240.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14518.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14083.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26133.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14518.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":30259.35},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31772.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14518.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14373.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14664.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31090.83},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":22456.63},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":39240.19},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14518.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13251.8,"10th_percentile":13251.8,"90th_percentile":13251.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":23371.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8388.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15565.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18022.59},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18923.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8561.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18517.82},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13375.25},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":23371.61},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":81019.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29977.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29077.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53958.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29977.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":62476.7},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65601.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29977.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29677.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30276.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64193.45},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":46366.35},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":81019.5},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29977.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":40029.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14811.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14366.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26659.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14811.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":30868.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32412.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14811.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14662.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14959.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31716.6},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":22908.61},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":40029.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14811.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":29509.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10591.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19653.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22755.95},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23894.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11027.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23381.25},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16888.07},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29509.82},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":54731.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20250.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19643.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36450.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20250.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":42204.96},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44315.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20250.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20453.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43364.68},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31321.92},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":54731.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20250.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9355.29,"maximum":26066.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9355.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17360.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20100.78},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21106.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9548.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9741.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20653.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14917.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26066.6},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":20827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7474.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13870.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16060.59},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16863.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7629.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16501.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11919.18},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20827.3},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":12498.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4624.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4485.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8323.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4624.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9637.69},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10119.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4624.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4578.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4670.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9902.52},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7152.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12498.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4624.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":9056.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3350.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3250.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6031.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3350.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":6983.85},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7333.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3350.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3317.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3384.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7175.76},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":5182.98},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":9056.63},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3350.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":95085.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35181.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34125.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63326.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35181.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":73323.1},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76990.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35181.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34829.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35533.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75337.9},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":54415.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":95085.07},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35181.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":36126.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12965.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24059.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27857.94},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29251.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13500.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28623.43},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20674.45},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36126.06},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2363.78,"10th_percentile":2363.78,"90th_percentile":2363.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":21121.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7580.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14067.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16287.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17102.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7893.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16735.2},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12087.68},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":21121.74},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7876.33,"10th_percentile":7876.33,"90th_percentile":7876.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":83210.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30787.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55418.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30787.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":64166.23},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67375.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30787.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30479.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31095.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65929.41},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":47620.22},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":83210.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30787.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":36153.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13376.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12975.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24078.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13376.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27879.31},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29273.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13376.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13243.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13510.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28645.39},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20690.31},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36153.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13376.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":25008.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9253.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8975.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16655.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9253.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19284.73},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20249.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9253.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9160.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9345.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19814.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14311.94},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25008.35},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9253.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":56028.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20730.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20108.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37314.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20730.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":43205.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45366.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20730.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20523.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20937.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44392.53},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":32064.33},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":56028.47},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20730.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40968.0,"10th_percentile":40968.0,"90th_percentile":40968.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20004.49,"10th_percentile":20004.49,"90th_percentile":20004.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20571.23,"10th_percentile":20571.23,"90th_percentile":20571.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":28255.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10141.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18818.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21788.98},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22878.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10350.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10559.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22387.7},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16170.44},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28255.85},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":17500.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6475.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6280.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11655.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6475.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13494.9},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14169.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6475.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6539.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13865.72},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10015.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17500.13},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6475.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":34549.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12399.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23010.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26642.55},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27975.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12655.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12911.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27374.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19772.46},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34549.94},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10898.73,"10th_percentile":10898.73,"90th_percentile":10898.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":21085.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7567.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14042.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16259.59},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17072.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7723.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7879.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16706.38},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12066.87},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":21085.37},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8245.39,"10th_percentile":8245.39,"90th_percentile":8245.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":14749.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5457.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5293.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9823.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5457.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11373.97},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11942.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5457.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5402.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5511.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11686.51},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8441.06},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14749.71},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5457.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":44902.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16613.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16115.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29904.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16613.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":34625.43},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36357.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16613.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16447.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16779.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35576.88},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":25696.86},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":44902.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16613.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":22658.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8383.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15090.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8383.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17472.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18346.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8383.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8467.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17952.43},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12966.88},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22658.02},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8383.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":14711.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5279.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9797.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11344.59},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11911.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5388.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5497.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11656.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8419.25},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14711.61},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":46928.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17363.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16842.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31254.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17363.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":36188.08},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37998.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17363.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17189.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17537.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37182.47},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":26856.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":46928.54},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17363.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":149982.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55493.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53828.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":99888.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55493.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":115656.28},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":121440.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55493.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54938.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56048.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118834.32},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":85832.96},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":149982.54},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55493.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":85536.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31648.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30699.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56967.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31648.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":65959.94},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69258.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31648.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31332.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31964.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67772.41},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":48951.4},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":85536.55},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31648.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":45288.0,"10th_percentile":32427.81,"90th_percentile":141525.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":29672.74,"10th_percentile":22524.8,"90th_percentile":30618.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":31618.18,"10th_percentile":21272.69,"90th_percentile":41146.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12865.68,"10th_percentile":12865.68,"90th_percentile":12865.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30658.62,"10th_percentile":18238.78,"90th_percentile":39613.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29889.89,"10th_percentile":29889.89,"90th_percentile":29889.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":49572.89,"10th_percentile":49572.89,"90th_percentile":181242.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":33042.0,"10th_percentile":33042.0,"90th_percentile":33042.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29229.58,"10th_percentile":28501.13,"90th_percentile":30934.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":34607.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12804.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12420.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23048.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12804.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26686.62},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28021.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12804.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12676.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12932.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27419.93},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19805.17},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34607.09},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12804.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":13139.46,"10th_percentile":13139.46,"90th_percentile":13139.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18208.0,"10th_percentile":2838.21,"90th_percentile":29681.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12701.08,"10th_percentile":12701.08,"90th_percentile":12946.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22073.69,"10th_percentile":22073.69,"90th_percentile":22227.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11846.94,"10th_percentile":11846.94,"90th_percentile":11846.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":12679.23,"10th_percentile":12679.23,"90th_percentile":12679.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":19198.42,"10th_percentile":19198.42,"90th_percentile":19805.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":9429.64,"10th_percentile":9429.64,"90th_percentile":9429.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12479.98,"10th_percentile":9901.06,"90th_percentile":13079.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":25931.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9306.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17270.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19996.6},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20996.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9594.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9498.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20546.08},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14840.25},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25931.5},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9594.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":14745.09,"10th_percentile":14745.09,"90th_percentile":14745.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":78783.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29149.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28275.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52469.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29149.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":60752.44},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63790.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29149.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28858.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29441.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62421.81},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":45086.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":78783.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29149.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28056.37,"10th_percentile":28056.37,"90th_percentile":28056.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":20479.85,"10th_percentile":20479.85,"90th_percentile":20479.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":37090.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13723.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13311.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24702.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13723.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":28601.87},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30032.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13723.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13586.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13860.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29387.8},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21226.55},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":37090.78},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13723.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22315.0,"10th_percentile":22315.0,"90th_percentile":22315.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1005.35,"10th_percentile":1005.35,"90th_percentile":1005.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":31475.63,"10th_percentile":31475.63,"90th_percentile":31475.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11989.16,"10th_percentile":11989.16,"90th_percentile":11989.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":21597.26,"10th_percentile":21597.26,"90th_percentile":21597.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14199.68,"10th_percentile":14199.68,"90th_percentile":14199.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":24125.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16067.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18603.57},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19534.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8836.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9015.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19114.77},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13806.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24125.03},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":31586.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11336.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21036.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24357.34},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25575.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11570.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11803.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25026.64},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18076.51},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31586.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11686.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18208.0,"10th_percentile":13639.0,"90th_percentile":27312.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11767.82,"10th_percentile":11195.34,"90th_percentile":11779.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":37366.0,"10th_percentile":37366.0,"90th_percentile":37366.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":17283.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6394.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6203.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11510.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6394.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13327.95},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13994.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6394.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6330.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6458.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13694.18},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9891.18},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17283.63},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6394.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7516.37,"10th_percentile":7516.37,"90th_percentile":7516.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1268.6,"10th_percentile":1268.6,"90th_percentile":10167.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2413.02,"10th_percentile":2413.02,"90th_percentile":2413.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6058.28,"10th_percentile":6058.28,"90th_percentile":6058.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15374.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5688.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5518.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10239.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5688.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11856.12},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12449.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5688.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5631.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12181.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8798.88},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15374.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5688.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":11823.25,"10th_percentile":11823.25,"90th_percentile":11823.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":25950.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9313.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17283.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20011.29},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21012.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9505.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9697.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20561.17},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14851.15},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25950.56},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9975.05,"10th_percentile":9975.05,"90th_percentile":9975.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10510.75,"10th_percentile":10510.75,"90th_percentile":10510.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6405.23,"10th_percentile":6405.23,"90th_percentile":6405.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15061.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5572.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10030.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5572.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11614.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12195.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5572.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5517.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11933.52},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8619.48},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15061.47},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5572.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6278.52,"10th_percentile":6278.52,"90th_percentile":6278.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5380.61,"10th_percentile":5380.61,"90th_percentile":5380.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":36254.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13011.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24145.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27956.78},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29355.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13279.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13548.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28724.98},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20747.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":36254.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":17858.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11893.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13771.37},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14460.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6673.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14149.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10220.26},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17858.65},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":12638.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4535.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8417.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9745.87},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10233.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4629.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4722.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10013.67},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7232.79},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":12638.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4676.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":119712.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42964.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79728.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":92314.0},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96931.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44293.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43850.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44736.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94850.63},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":68509.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":119712.38},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44293.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37664.98,"10th_percentile":37664.98,"90th_percentile":37664.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49093.0,"10th_percentile":44798.0,"90th_percentile":58632.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42124.66,"10th_percentile":42124.66,"90th_percentile":42124.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45051.84,"10th_percentile":45051.84,"90th_percentile":45051.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37494.52,"10th_percentile":37494.52,"90th_percentile":37494.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54829.46,"10th_percentile":42174.94,"90th_percentile":71676.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43427.48,"10th_percentile":43427.48,"90th_percentile":43427.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":67849.63,"10th_percentile":67849.63,"90th_percentile":67849.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40403.36,"10th_percentile":40403.36,"90th_percentile":40403.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":33644.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12448.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12074.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22406.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12448.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25944.03},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27241.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12448.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12323.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26656.93},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19254.06},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33644.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12448.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":12811.12,"10th_percentile":11358.68,"90th_percentile":12915.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"52","median_amount":13556.0,"10th_percentile":3389.0,"90th_percentile":33568.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"66","median_amount":12464.51,"10th_percentile":10058.06,"90th_percentile":12625.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21756.03,"10th_percentile":21756.03,"90th_percentile":21815.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"62","median_amount":12865.68,"10th_percentile":10841.98,"90th_percentile":13527.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":27754.05,"10th_percentile":27754.05,"90th_percentile":27754.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11118.01,"10th_percentile":7747.0,"90th_percentile":13128.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"27","median_amount":11515.03,"10th_percentile":5944.59,"90th_percentile":12780.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11452.01,"10th_percentile":11452.01,"90th_percentile":11452.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":197004.72,"10th_percentile":197004.72,"90th_percentile":197004.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"16","median_amount":18326.26,"10th_percentile":11600.01,"90th_percentile":41393.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":15323.0,"10th_percentile":8509.36,"90th_percentile":31998.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"32","median_amount":11517.93,"10th_percentile":8157.92,"90th_percentile":12893.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":17723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6360.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11803.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13667.19},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14350.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6492.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6623.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14042.75},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10142.95},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17723.56},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6557.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6251.72,"10th_percentile":6251.72,"90th_percentile":6251.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":7650.0,"10th_percentile":1543.71,"90th_percentile":12750.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7127.23,"10th_percentile":5062.89,"90th_percentile":7165.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13462.99,"10th_percentile":13462.99,"90th_percentile":13462.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6788.72,"10th_percentile":6778.8,"90th_percentile":11042.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5912.09,"10th_percentile":5912.09,"90th_percentile":6656.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":21068.33,"10th_percentile":21068.33,"90th_percentile":34941.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6921.17,"10th_percentile":6921.17,"90th_percentile":6921.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7359.83,"10th_percentile":5772.35,"90th_percentile":7380.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":66940.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24767.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24024.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44582.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24767.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":51619.6},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54201.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24767.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24520.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25015.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53038.02},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":38308.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":66940.07},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24767.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10000.0,"10th_percentile":10000.0,"90th_percentile":10000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":16630.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6153.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5968.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11076.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6153.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12824.43},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13465.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6153.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6091.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6214.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13176.82},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9517.5},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16630.66},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6153.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9842.47,"10th_percentile":9842.47,"90th_percentile":9842.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6803.23,"10th_percentile":6803.23,"90th_percentile":6803.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":8360.74,"10th_percentile":8360.74,"90th_percentile":8360.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"1 through 10","median_amount":5781.0,"10th_percentile":5781.0,"90th_percentile":5781.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6625.11,"10th_percentile":6625.11,"90th_percentile":6625.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":16296.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6029.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5848.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10853.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6029.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12566.66},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13195.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6029.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5969.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6089.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12911.97},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9326.2},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16296.39},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6029.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6700.0,"10th_percentile":6700.0,"90th_percentile":6700.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4057.18,"10th_percentile":4057.18,"90th_percentile":4057.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":18598.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6881.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6674.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12386.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6881.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14341.67},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15058.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6881.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6812.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6950.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14735.76},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10643.51},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18598.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6881.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3000.0,"10th_percentile":2045.0,"90th_percentile":7000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":34056.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12600.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12222.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22681.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12600.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26261.9},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27575.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12600.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12474.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12726.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26983.53},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19489.97},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34056.32},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12600.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":27866.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10001.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18558.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21488.47},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22563.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10413.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22078.93},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15947.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27866.15},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":16774.07,"10th_percentile":16774.07,"90th_percentile":16774.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11700.0,"10th_percentile":11700.0,"90th_percentile":11700.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"12","median_amount":13868.4,"10th_percentile":7445.6,"90th_percentile":25247.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10836.91,"10th_percentile":10825.1,"90th_percentile":19972.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":13499.21,"10th_percentile":9074.78,"90th_percentile":47458.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13889.85,"10th_percentile":13889.85,"90th_percentile":38455.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11357.14,"10th_percentile":11357.14,"90th_percentile":11357.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"15","median_amount":8687.0,"10th_percentile":4689.0,"90th_percentile":42194.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10712.0,"10th_percentile":10712.0,"90th_percentile":15064.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":24192.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8682.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16112.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18655.66},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19588.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8861.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9040.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19168.29},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13845.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24192.58},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"1 through 10","median_amount":7834.46,"10th_percentile":1640.51,"90th_percentile":16834.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":2620.54,"10th_percentile":2620.54,"90th_percentile":2620.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"103","median_amount":6099.74,"10th_percentile":2216.75,"90th_percentile":13000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"1 through 10","median_amount":4517.8,"10th_percentile":2646.0,"90th_percentile":11348.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11025.0,"10th_percentile":11025.0,"90th_percentile":11025.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"1 through 10","median_amount":4368.0,"10th_percentile":4368.0,"90th_percentile":4368.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10978.06,"10th_percentile":5285.95,"90th_percentile":14474.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10356.1,"10th_percentile":10356.1,"90th_percentile":11032.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"14","median_amount":5884.15,"10th_percentile":2902.77,"90th_percentile":16857.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7556.61,"10th_percentile":6809.09,"90th_percentile":13935.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":6820.03,"10th_percentile":3762.6,"90th_percentile":18111.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":9184.02,"10th_percentile":4938.88,"90th_percentile":30276.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"51","median_amount":7446.0,"10th_percentile":2792.25,"90th_percentile":21291.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"1 through 10","median_amount":4653.75,"10th_percentile":4653.75,"90th_percentile":4653.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"45","median_amount":9928.0,"10th_percentile":4964.0,"90th_percentile":24820.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"1 through 10","median_amount":1336.8,"10th_percentile":1336.8,"90th_percentile":1336.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":8608.0,"10th_percentile":3505.0,"90th_percentile":15064.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":35944.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13299.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12900.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23938.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13299.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27717.71},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29104.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13299.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13166.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13432.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28479.34},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20570.37},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":35944.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13299.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":18547.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6656.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12352.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":14302.94},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15018.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6794.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6931.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14695.96},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10614.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":18547.99},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":10684.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3953.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3834.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7116.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3953.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8239.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8651.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3953.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3913.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3992.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8465.72},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6114.71},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":10684.71},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3953.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":8704.54,"10th_percentile":8704.54,"90th_percentile":8704.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7055.01,"10th_percentile":7055.01,"90th_percentile":7055.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":24518.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9071.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8799.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16329.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9071.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":18906.75},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19852.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9071.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8981.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19426.28},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14031.43},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":24518.19},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9071.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":30225.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11183.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10847.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20129.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11183.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23307.56},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24473.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11183.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11071.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11295.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23948.01},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17297.43},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30225.13},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11183.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12703.21,"10th_percentile":12703.21,"90th_percentile":12703.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2613.82,"10th_percentile":1630.44,"90th_percentile":5000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21651.03,"10th_percentile":21651.03,"90th_percentile":21651.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10577.66,"10th_percentile":10577.66,"90th_percentile":10577.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6129.69,"10th_percentile":6129.69,"90th_percentile":6129.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":17533.39,"10th_percentile":16257.0,"90th_percentile":26045.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8853.85,"10th_percentile":8853.85,"90th_percentile":8853.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1000.0,"maximum":15290.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5657.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1000.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5487.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10183.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5657.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11790.68},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12380.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5657.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5600.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5713.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12114.66},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8750.31},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15290.1},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5657.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":11966.56,"10th_percentile":11966.56,"90th_percentile":11966.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2498.78,"10th_percentile":800.0,"90th_percentile":10300.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8792.04,"10th_percentile":8792.04,"90th_percentile":11486.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4786.81,"10th_percentile":4786.81,"90th_percentile":4786.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":3295.84,"10th_percentile":3295.84,"90th_percentile":9928.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"1 through 10","median_amount":10367.87,"10th_percentile":10367.87,"90th_percentile":10367.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"1 through 10","median_amount":7037.0,"10th_percentile":7037.0,"90th_percentile":9928.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":72685.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26893.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26086.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48408.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26893.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":56049.79},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58853.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26893.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26624.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27162.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57589.94},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":41596.7},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":72685.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26893.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":33159.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22083.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":25570.06},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26848.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12146.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12391.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26272.68},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18976.52},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":33159.14},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13106.07,"10th_percentile":13106.07,"90th_percentile":13106.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":20257.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7495.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13491.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7495.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15621.18},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16402.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7495.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7570.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16050.42},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11593.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20257.47},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7495.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":63618.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22832.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42369.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":49057.92},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51511.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23303.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23774.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50405.95},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":36407.77},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":63618.09},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23538.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":25692.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9506.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17111.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9506.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":19812.29},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20803.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9506.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9411.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9601.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20356.7},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":14703.46},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":25692.49},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9506.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":34021.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12588.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22658.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12588.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26235.19},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27547.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12588.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12462.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12713.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26956.09},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19470.14},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34021.68},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12588.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2518.02,"10th_percentile":2518.02,"90th_percentile":2518.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":66496.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24603.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23865.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44286.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24603.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":51277.69},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53842.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24603.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24357.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24849.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52686.71},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":38055.14},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":66496.68},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24603.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6258.07,"10th_percentile":6258.07,"90th_percentile":6258.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8469.5,"10th_percentile":8469.5,"90th_percentile":8469.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":19993.5,"10th_percentile":19993.5,"90th_percentile":19993.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":34556.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12402.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23014.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":26647.89},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27980.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12658.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12913.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27380.13},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":19776.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":34556.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12786.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22864.0,"10th_percentile":22864.0,"90th_percentile":51649.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12837.49,"10th_percentile":12837.49,"90th_percentile":12837.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":22735.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8412.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8159.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15142.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8412.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17532.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18409.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8412.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8328.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18014.18},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":13011.48},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22735.96},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8412.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29692.0,"10th_percentile":29692.0,"90th_percentile":29692.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9189.82,"10th_percentile":9189.82,"90th_percentile":9189.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":28311.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10475.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10160.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18855.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10475.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21831.72},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22923.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10475.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10370.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10579.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22431.62},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16202.16},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28311.27},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10475.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15336.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5674.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5504.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10214.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5674.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11826.74},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12418.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5674.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5617.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12151.72},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8777.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15336.86},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5674.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":29125.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10776.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10453.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19397.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10776.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22459.45},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23582.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10776.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10668.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10884.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23076.6},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16668.02},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29125.31},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10776.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4104.94,"10th_percentile":4104.94,"90th_percentile":4104.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":11540.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4269.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4141.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7685.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4269.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8899.1},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9344.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4269.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4227.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4312.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9143.63},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6604.37},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11540.32},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4269.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4427.65,"10th_percentile":4427.65,"90th_percentile":4427.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2340.92,"10th_percentile":2340.92,"90th_percentile":2340.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":27164.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10050.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9749.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18091.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10050.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20947.55},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21995.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10050.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9950.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10151.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21523.15},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15545.98},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":27164.69},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10050.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10988.26,"10th_percentile":10988.26,"90th_percentile":10988.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":12014.56,"10th_percentile":1269.44,"90th_percentile":32794.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10620.43,"10th_percentile":10620.43,"90th_percentile":10620.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16340.96,"10th_percentile":16340.96,"90th_percentile":16340.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11496.31,"10th_percentile":11496.31,"90th_percentile":11496.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":2594.45,"10th_percentile":2594.45,"90th_percentile":2594.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10656.55,"10th_percentile":10656.55,"90th_percentile":10656.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10015.97,"10th_percentile":10015.97,"90th_percentile":10839.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":15042.96,"10th_percentile":13293.69,"90th_percentile":15688.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10948.87,"10th_percentile":8161.79,"90th_percentile":10963.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":14844.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5327.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9886.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":11447.43},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12019.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5437.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5547.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11761.98},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8495.58},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":14844.97},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5492.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"1 through 10","median_amount":8397.53,"10th_percentile":8397.53,"90th_percentile":8397.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":7104.0,"10th_percentile":2558.42,"90th_percentile":14350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5151.9,"10th_percentile":5151.9,"90th_percentile":5151.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":9455.94,"10th_percentile":9455.94,"90th_percentile":12047.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":2939.16,"10th_percentile":2939.16,"90th_percentile":2939.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":31709.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11380.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21118.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":24452.16},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25675.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11615.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11849.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25124.07},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":18146.89},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":31709.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11732.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1668.56,"10th_percentile":1668.56,"90th_percentile":1668.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12656.35,"10th_percentile":12656.35,"90th_percentile":12656.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2389.74,"10th_percentile":2389.74,"90th_percentile":2389.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":22471.52,"10th_percentile":22471.52,"90th_percentile":22471.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":18075.52,"10th_percentile":18075.52,"90th_percentile":18075.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":17359.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6423.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6230.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11561.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6423.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13386.72},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14056.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6423.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6358.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6487.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13754.56},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9934.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17359.84},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6423.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":11923.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4411.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4279.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7940.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4411.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":9194.27},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9654.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4411.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4367.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4455.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9446.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6823.42},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":11923.09},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4411.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"1 through 10","median_amount":6816.48,"10th_percentile":6816.48,"90th_percentile":6816.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":30299.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20179.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":23364.99},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24533.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11098.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11322.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24007.02},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":17340.05},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":30299.61},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11210.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10612.27,"10th_percentile":10612.27,"90th_percentile":10612.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":17626.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6521.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11739.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6521.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":13592.4},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14272.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6521.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6456.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6587.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13965.9},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":10087.44},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":17626.56},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6521.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7063.35,"10th_percentile":7063.35,"90th_percentile":7063.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":369790.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136822.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":132717.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":246280.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136822.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":285157.28},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":299419.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136822.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135454.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138190.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":292992.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":211626.16},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":369790.66},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":136822.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":124231.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45965.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44586.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82737.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45965.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":95798.58},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":100589.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45965.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45505.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46425.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98430.96},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":71095.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":124231.16},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45965.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":55784.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20640.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20020.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37152.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20640.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":43017.0},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45168.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20640.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20433.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20846.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44199.04},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":31924.57},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":55784.26},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20640.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12705.0,"maximum":67447.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24955.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24206.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44920.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24955.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":52010.94},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54612.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24955.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24706.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25205.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53440.11},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":38599.31},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":67447.54},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24955.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":38287.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14166.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13741.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25499.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14166.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":29524.77},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31001.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14166.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14024.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14308.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30336.06},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":21911.47},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":38287.59},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14166.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":35679.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13201.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12805.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23762.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13201.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27513.36},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28889.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13201.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13069.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13333.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28269.38},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20418.72},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":35679.2},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13201.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22410.0,"10th_percentile":22410.0,"90th_percentile":22410.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":62845.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23252.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22555.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41855.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23252.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":48462.25},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50886.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23252.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23020.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23485.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49793.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":35965.69},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":62845.62},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23252.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":40475.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14526.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26956.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":31211.64},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32772.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14826.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32069.28},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23163.35},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":40475.11},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14975.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":35119.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12994.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12604.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23389.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12994.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":27081.96},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28436.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12994.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12864.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27826.13},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":20098.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":35119.76},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12994.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":26821.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9924.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9626.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17863.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9924.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20683.1},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21717.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9924.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9824.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10023.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21251.44},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15349.72},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26821.75},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9924.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":19862.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7349.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13228.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7349.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15316.66},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16082.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7349.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7422.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15737.54},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11367.08},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":19862.58},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7349.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":21986.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7890.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14642.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16954.11},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17802.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8216.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17419.98},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12582.29},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":21986.01},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3489.0,"10th_percentile":3489.0,"90th_percentile":3489.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2183.25,"10th_percentile":2183.25,"90th_percentile":2183.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":13864.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9233.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":10691.48},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11226.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5078.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5181.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10985.26},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":7934.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":13864.66},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":20605.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7395.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13723.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":15889.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16684.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7547.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16326.25},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11792.31},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20605.6},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7624.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":10871.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4022.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3901.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7240.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4022.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":8383.56},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8802.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4022.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3982.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4062.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8613.93},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":6221.76},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":10871.76},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4022.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3456.18,"maximum":9629.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3563.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3456.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6413.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3563.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":7425.94},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7797.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3563.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3527.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3598.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7629.99},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":5511.07},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":9629.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3563.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22760.0,"10th_percentile":22760.0,"90th_percentile":35354.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4149.74,"10th_percentile":4149.74,"90th_percentile":4149.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4499.75,"10th_percentile":4499.75,"90th_percentile":4499.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"1 through 10","median_amount":9105.29,"10th_percentile":9105.29,"90th_percentile":9105.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":116582.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43135.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41841.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77643.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43135.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":89900.57},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":94396.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43135.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42704.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43566.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92370.89},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":66718.66},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":116582.65},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43135.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":65175.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24114.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23391.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43406.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24114.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":50258.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52772.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24114.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23873.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24355.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51639.65},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":37298.86},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":65175.16},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24114.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25194.36,"10th_percentile":25194.36,"90th_percentile":25194.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":131976.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48831.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47366.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87896.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48831.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":101771.38},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":106861.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48831.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48342.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49319.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104567.89},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":75528.45},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":131976.67},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48831.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":72984.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26194.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":56280.85},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59095.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26734.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27274.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57827.35},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":41768.18},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":72984.75},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27004.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":50991.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18866.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18300.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33960.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18866.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":39321.4},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41288.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18866.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18678.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19055.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40401.88},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":29181.92},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":50991.81},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18866.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":47349.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17519.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16993.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31534.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17519.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":36512.63},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38338.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17519.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17344.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17694.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37515.94},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":27097.43},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":47349.42},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17519.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":26544.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9821.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9526.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17678.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9821.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":20469.41},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21493.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9821.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9919.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21031.87},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":15191.13},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":26544.63},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9821.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":16289.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6027.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5846.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10848.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6027.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12561.32},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13189.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6027.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6087.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12906.48},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":9322.24},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":16289.46},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6027.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.0,"maximum":106020.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39227.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5661.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38050.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70609.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39227.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":81756.08},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":85845.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39227.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38835.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39619.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84002.6},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":60674.33},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":106020.92},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39227.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":73593.0,"10th_percentile":73593.0,"90th_percentile":73593.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":45679.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16901.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16394.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30422.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16901.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":35225.11},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36986.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16901.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16732.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17070.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36193.04},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":26141.91},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":45679.77},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16901.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":49985.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18494.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17939.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33290.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18494.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":38545.42},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40473.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18494.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18309.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18679.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39604.58},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":28606.03},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":49985.52},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18494.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2550.0,"maximum":22429.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8298.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2550.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8049.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14937.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8298.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17296.02},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18161.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8298.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8215.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8381.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17771.29},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12836.04},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22429.4},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8298.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":136340.27,"10th_percentile":136340.27,"90th_percentile":136340.27},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":15634.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5611.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10412.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":12056.46},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12659.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5727.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5842.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12387.75},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":8947.56},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":15634.76},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5784.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":22476.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8316.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8066.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14969.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8316.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":17332.08},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18198.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8316.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8233.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8399.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17808.34},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":12862.8},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":22476.16},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8316.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":81261.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30066.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29164.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54120.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30066.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":62663.68},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65797.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30066.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29766.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64385.57},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":46505.12},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":81261.98},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30066.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90917.0,"10th_percentile":90917.0,"90th_percentile":90917.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28580.35,"10th_percentile":28580.35,"90th_percentile":28580.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28756.99,"10th_percentile":28756.99,"90th_percentile":28756.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31565.89,"10th_percentile":31565.89,"90th_percentile":31565.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29208.04,"10th_percentile":29208.04,"90th_percentile":29208.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13150.57,"10th_percentile":13150.57,"90th_percentile":13150.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7623.0,"maximum":42581.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7623.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15282.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28359.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":32835.73},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34478.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15597.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15912.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33738.0},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":24368.65},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":42581.22},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16055.88,"10th_percentile":16055.88,"90th_percentile":16055.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14007.25,"10th_percentile":14007.25,"90th_percentile":14007.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13551.07,"10th_percentile":13551.07,"90th_percentile":13551.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10654.46,"maximum":29686.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10983.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12705.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19771.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10983.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":22892.18},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24037.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10983.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23521.22},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16989.17},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":29686.48},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10983.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":3389.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":4552.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":4552.0,"payers_information":[{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":59379.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21311.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39546.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":45789.71},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48079.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21750.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22190.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47047.93},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":33982.3},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":59379.89},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21970.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23612.0,"10th_percentile":23612.0,"90th_percentile":23612.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21364.34,"10th_percentile":21364.34,"90th_percentile":21364.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27438.02,"10th_percentile":27438.02,"90th_percentile":27438.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18353.48,"10th_percentile":18353.48,"90th_percentile":21804.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3389.0,"maximum":28467.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10532.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3389.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10216.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18959.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10532.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":21951.92},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23049.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10532.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10427.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10638.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22555.12},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":16291.36},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":28467.15},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10532.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11972.41,"10th_percentile":11972.41,"90th_percentile":11972.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.0,"maximum":20770.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4552.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7454.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13832.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":16016.52},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16817.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7608.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7761.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16456.62},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":11886.47},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":20770.14},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15007.63,"maximum":41815.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15471.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15007.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27849.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15471.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":32245.39},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33858.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15471.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15317.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15626.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33131.44},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":23930.54},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":41815.68},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15471.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21374.81,"maximum":59556.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22035.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21374.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39664.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22035.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":45925.94},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48222.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22035.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21815.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22256.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47187.91},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":34083.4},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":59556.55},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22035.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15056.74,"maximum":41952.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15056.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27940.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":32350.9},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33968.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15367.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15677.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33239.85},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":24008.85},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":41952.5},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35474.89,"maximum":98843.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36572.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35474.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65829.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36572.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":76221.36},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80033.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36572.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36206.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36937.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78315.79},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":56566.79},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":98843.51},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36572.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70359.24,"maximum":196041.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72535.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70359.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":130563.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72535.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"fee schedule","standard_charge_dollar":151173.89},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":158734.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72535.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71809.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73260.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":155327.89},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"fee schedule","standard_charge_dollar":112191.95},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"fee schedule","standard_charge_dollar":196041.62},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72535.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, glycopyrrolate, 0.1 mg","code_information":[{"code":"0792","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":7667.45,"10th_percentile":7259.27,"90th_percentile":8976.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Visualization adjunct","code_information":[{"code":"1446","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":4683.72,"10th_percentile":4683.72,"90th_percentile":4683.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"35","median_amount":110.6,"10th_percentile":91.19,"90th_percentile":114.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"268","median_amount":249.25,"10th_percentile":44.54,"90th_percentile":291.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"187","median_amount":113.98,"10th_percentile":109.35,"90th_percentile":129.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"59","median_amount":113.98,"10th_percentile":20.0,"90th_percentile":122.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"13","median_amount":20.0,"10th_percentile":20.0,"90th_percentile":20.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":91.31,"10th_percentile":90.3,"90th_percentile":116.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"65","median_amount":112.85,"10th_percentile":108.8,"90th_percentile":132.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"16","median_amount":120.17,"10th_percentile":118.7,"90th_percentile":348.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"28","median_amount":86.72,"10th_percentile":65.04,"90th_percentile":231.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"16","median_amount":250.63,"10th_percentile":250.63,"90th_percentile":303.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"69","median_amount":113.98,"10th_percentile":109.35,"90th_percentile":138.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":8.04,"10th_percentile":8.04,"90th_percentile":8.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":79.47,"10th_percentile":79.47,"90th_percentile":79.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":56.88,"10th_percentile":56.88,"90th_percentile":56.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"43","median_amount":196.3,"10th_percentile":136.3,"90th_percentile":395.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":79.47,"10th_percentile":76.24,"90th_percentile":325.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":81.77,"10th_percentile":80.05,"90th_percentile":83.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":417.0,"10th_percentile":417.0,"90th_percentile":417.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":78.68,"10th_percentile":78.68,"90th_percentile":78.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":353.77,"10th_percentile":93.6,"90th_percentile":491.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":231.75,"10th_percentile":231.75,"90th_percentile":291.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":275.87,"10th_percentile":275.87,"90th_percentile":275.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":424.48,"10th_percentile":424.48,"90th_percentile":424.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":200.0,"10th_percentile":200.0,"90th_percentile":200.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"14","median_amount":56.34,"10th_percentile":32.27,"90th_percentile":190.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":114.12,"10th_percentile":113.44,"90th_percentile":313.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"197","median_amount":282.94,"10th_percentile":116.7,"90th_percentile":449.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":138.37,"10th_percentile":136.77,"90th_percentile":142.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":257.27,"10th_percentile":257.27,"90th_percentile":257.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":143.59,"10th_percentile":24.58,"90th_percentile":149.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":502.0,"10th_percentile":502.0,"90th_percentile":502.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":181.6,"10th_percentile":181.6,"90th_percentile":181.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":142.93,"10th_percentile":97.4,"90th_percentile":142.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":140.87,"10th_percentile":36.61,"90th_percentile":141.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"18","median_amount":417.0,"10th_percentile":25.0,"90th_percentile":1323.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"30","median_amount":231.75,"10th_percentile":231.75,"90th_percentile":369.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":309.0,"10th_percentile":309.0,"90th_percentile":309.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":777.0,"10th_percentile":477.0,"90th_percentile":777.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":138.37,"10th_percentile":18.37,"90th_percentile":451.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":1810.0,"10th_percentile":750.0,"90th_percentile":3283.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"61","median_amount":214.99,"10th_percentile":137.11,"90th_percentile":352.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"26","median_amount":270.31,"10th_percentile":119.84,"90th_percentile":669.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1063","median_amount":288.9,"10th_percentile":105.38,"90th_percentile":556.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"120","median_amount":247.41,"10th_percentile":122.41,"90th_percentile":372.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":337.38,"10th_percentile":196.73,"90th_percentile":571.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"88","median_amount":249.2,"10th_percentile":134.66,"90th_percentile":330.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"37","median_amount":948.0,"10th_percentile":518.4,"90th_percentile":1065.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":1100.0,"10th_percentile":1100.0,"90th_percentile":1100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":249.91,"10th_percentile":124.91,"90th_percentile":392.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"57","median_amount":236.84,"10th_percentile":66.17,"90th_percentile":322.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":300.0,"10th_percentile":300.0,"90th_percentile":300.0},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":374.87,"10th_percentile":374.87,"90th_percentile":374.87},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":331.81,"10th_percentile":331.81,"90th_percentile":345.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"72","median_amount":604.0,"10th_percentile":56.88,"90th_percentile":996.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"211","median_amount":419.25,"10th_percentile":419.25,"90th_percentile":581.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":559.0,"10th_percentile":555.0,"90th_percentile":952.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"35","median_amount":678.59,"10th_percentile":477.0,"90th_percentile":777.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"83","median_amount":237.15,"10th_percentile":127.15,"90th_percentile":384.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":3274.91,"10th_percentile":3274.91,"90th_percentile":3274.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":380.0,"10th_percentile":162.57,"90th_percentile":5058.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"75","median_amount":470.7,"10th_percentile":269.33,"90th_percentile":687.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"51","median_amount":460.0,"10th_percentile":117.51,"90th_percentile":1058.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1594","median_amount":406.02,"10th_percentile":127.59,"90th_percentile":878.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"225","median_amount":459.63,"10th_percentile":363.82,"90th_percentile":642.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":626.13,"10th_percentile":290.09,"90th_percentile":968.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"175","median_amount":476.61,"10th_percentile":272.98,"90th_percentile":700.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"52","median_amount":588.46,"10th_percentile":321.87,"90th_percentile":1448.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"11","median_amount":449.7,"10th_percentile":300.0,"90th_percentile":1048.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"51","median_amount":384.33,"10th_percentile":242.05,"90th_percentile":587.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"123","median_amount":377.06,"10th_percentile":179.02,"90th_percentile":588.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":330.0,"10th_percentile":330.0,"90th_percentile":330.0},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":986.5,"10th_percentile":986.5,"90th_percentile":986.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"133","median_amount":1360.14,"10th_percentile":178.65,"90th_percentile":2273.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"319","median_amount":1264.5,"10th_percentile":391.3,"90th_percentile":1686.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":2148.0,"10th_percentile":1624.15,"90th_percentile":3638.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"73","median_amount":754.0,"10th_percentile":277.0,"90th_percentile":777.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"146","median_amount":472.9,"10th_percentile":343.74,"90th_percentile":695.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":3877.59,"10th_percentile":590.0,"90th_percentile":6240.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"141","median_amount":818.73,"10th_percentile":622.37,"90th_percentile":1144.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"62","median_amount":1686.36,"10th_percentile":507.81,"90th_percentile":2948.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"2547","median_amount":872.36,"10th_percentile":310.48,"90th_percentile":1420.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"469","median_amount":881.55,"10th_percentile":618.41,"90th_percentile":1169.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"68","median_amount":1240.62,"10th_percentile":246.09,"90th_percentile":1944.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"314","median_amount":896.09,"10th_percentile":634.08,"90th_percentile":1239.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"73","median_amount":853.42,"10th_percentile":318.36,"90th_percentile":2505.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":1631.6,"10th_percentile":633.39,"90th_percentile":3066.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"70","median_amount":797.79,"10th_percentile":481.71,"90th_percentile":1124.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"257","median_amount":725.3,"10th_percentile":450.54,"90th_percentile":1033.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1153.05,"10th_percentile":400.0,"90th_percentile":1578.27},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":864.63,"10th_percentile":649.34,"90th_percentile":1476.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"243","median_amount":1990.45,"10th_percentile":615.83,"90th_percentile":7261.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"438","median_amount":1264.5,"10th_percentile":559.0,"90th_percentile":1687.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":2273.0,"10th_percentile":1670.0,"90th_percentile":3742.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"87","median_amount":754.0,"10th_percentile":477.0,"90th_percentile":777.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"279","median_amount":884.98,"10th_percentile":620.17,"90th_percentile":1289.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1270.56,"10th_percentile":1270.56,"90th_percentile":1270.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":992.15,"10th_percentile":341.41,"90th_percentile":10396.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1725.96,"10th_percentile":1449.28,"90th_percentile":6906.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9902.24,"10th_percentile":9902.24,"90th_percentile":9902.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5808.95,"10th_percentile":5808.95,"90th_percentile":5808.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1555.0,"10th_percentile":1555.0,"90th_percentile":1555.0},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":3511.0,"10th_percentile":3511.0,"90th_percentile":3511.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1583.71,"10th_percentile":1583.71,"90th_percentile":1603.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"15","median_amount":140.6,"10th_percentile":95.39,"90th_percentile":305.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"301","median_amount":320.31,"10th_percentile":74.31,"90th_percentile":340.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"108","median_amount":179.34,"10th_percentile":166.44,"90th_percentile":383.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":184.54,"10th_percentile":45.0,"90th_percentile":310.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":169.84,"10th_percentile":169.84,"90th_percentile":179.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"54","median_amount":165.68,"10th_percentile":129.9,"90th_percentile":289.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":797.0,"10th_percentile":551.82,"90th_percentile":956.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"30","median_amount":956.0,"10th_percentile":524.0,"90th_percentile":1673.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"17","median_amount":405.29,"10th_percentile":405.29,"90th_percentile":430.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":175.75,"10th_percentile":166.44,"90th_percentile":290.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"75","median_amount":644.21,"10th_percentile":514.21,"90th_percentile":1523.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":347.17,"10th_percentile":64.29,"90th_percentile":858.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":371.06,"10th_percentile":101.96,"90th_percentile":463.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":1412.0,"10th_percentile":1412.0,"90th_percentile":1412.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":350.44,"10th_percentile":305.75,"90th_percentile":361.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":1323.0,"10th_percentile":1323.0,"90th_percentile":1588.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"12","median_amount":956.0,"10th_percentile":956.0,"90th_percentile":1434.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":1017.02,"10th_percentile":970.82,"90th_percentile":1351.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":353.89,"10th_percentile":30.0,"90th_percentile":493.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":287.48,"10th_percentile":287.48,"90th_percentile":287.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"17","median_amount":644.21,"10th_percentile":534.21,"90th_percentile":919.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":633.01,"10th_percentile":633.01,"90th_percentile":633.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":575.5,"10th_percentile":575.5,"90th_percentile":575.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":536.32,"10th_percentile":536.32,"90th_percentile":536.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":1323.0,"10th_percentile":1323.0,"90th_percentile":1323.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":956.0,"10th_percentile":956.0,"90th_percentile":956.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":905.84,"10th_percentile":905.84,"90th_percentile":905.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1286.82,"10th_percentile":1286.82,"90th_percentile":1286.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":3355.71,"10th_percentile":3355.71,"90th_percentile":3515.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1652.72,"10th_percentile":1652.72,"90th_percentile":1652.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1516.12,"10th_percentile":1516.12,"90th_percentile":1547.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1754.5,"10th_percentile":1754.5,"90th_percentile":1754.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1888.69,"10th_percentile":1888.69,"90th_percentile":1888.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2652.84,"10th_percentile":2652.84,"90th_percentile":2652.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"60","median_amount":487.88,"10th_percentile":390.3,"90th_percentile":487.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"67","median_amount":644.21,"10th_percentile":632.04,"90th_percentile":644.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"154","median_amount":487.88,"10th_percentile":468.05,"90th_percentile":517.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":461.45,"10th_percentile":461.45,"90th_percentile":512.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":483.4,"10th_percentile":483.0,"90th_percentile":483.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"43","median_amount":3798.44,"10th_percentile":3597.56,"90th_percentile":3997.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":461.46,"10th_percentile":461.46,"90th_percentile":461.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":624.87,"10th_percentile":624.87,"90th_percentile":624.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"28","median_amount":1574.23,"10th_percentile":763.88,"90th_percentile":2761.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":596.88,"10th_percentile":353.23,"90th_percentile":628.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":658.44,"10th_percentile":560.34,"90th_percentile":658.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":710.03,"10th_percentile":710.03,"90th_percentile":710.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":623.1,"10th_percentile":623.1,"90th_percentile":623.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1433.0,"10th_percentile":1433.0,"90th_percentile":1433.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":622.33,"10th_percentile":622.33,"90th_percentile":622.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":2393.27,"10th_percentile":2393.27,"90th_percentile":2393.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"56","median_amount":2484.27,"10th_percentile":1266.41,"90th_percentile":2989.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":1439.01,"10th_percentile":1350.9,"90th_percentile":1463.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2173.74,"10th_percentile":2173.74,"90th_percentile":2173.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":1411.67,"10th_percentile":1212.77,"90th_percentile":2591.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":1789.48,"10th_percentile":1789.48,"90th_percentile":1789.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1462.36,"10th_percentile":1462.36,"90th_percentile":1646.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1501.62,"10th_percentile":1497.4,"90th_percentile":1717.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"12","median_amount":2429.0,"10th_percentile":2206.2,"90th_percentile":4866.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1754.0,"10th_percentile":1365.5,"90th_percentile":2711.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":5491.68,"10th_percentile":5491.68,"90th_percentile":5491.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1433.61,"10th_percentile":1101.31,"90th_percentile":1513.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":3585.44,"10th_percentile":3585.44,"90th_percentile":3585.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"48","median_amount":2989.42,"10th_percentile":1719.02,"90th_percentile":4156.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":2525.04,"10th_percentile":2367.26,"90th_percentile":2553.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2549.94,"10th_percentile":1411.67,"90th_percentile":2663.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2410.57,"10th_percentile":2410.57,"90th_percentile":2410.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":5412.25,"10th_percentile":5412.25,"90th_percentile":5412.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1990.35,"10th_percentile":1875.74,"90th_percentile":4381.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":3947.09,"10th_percentile":3947.09,"90th_percentile":4784.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2425.51,"10th_percentile":2258.01,"90th_percentile":2539.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4661.57,"10th_percentile":4661.57,"90th_percentile":4661.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"23","median_amount":4953.08,"10th_percentile":3727.26,"90th_percentile":9386.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5441.4,"10th_percentile":3246.17,"90th_percentile":5846.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6111.19,"10th_percentile":6111.19,"90th_percentile":6111.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3233.67,"10th_percentile":3233.67,"90th_percentile":3233.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5970.61,"10th_percentile":5970.61,"90th_percentile":5970.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2257.51,"10th_percentile":2257.51,"90th_percentile":2257.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":34368.12,"10th_percentile":34368.12,"90th_percentile":34368.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":5512.0,"10th_percentile":5512.0,"90th_percentile":5512.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3394.53,"10th_percentile":3394.53,"90th_percentile":3394.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":5549.06,"10th_percentile":5549.06,"90th_percentile":5549.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5525.7,"10th_percentile":5525.7,"90th_percentile":5525.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. 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Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":187.48,"10th_percentile":157.2,"90th_percentile":275.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"13","median_amount":139.56,"10th_percentile":100.0,"90th_percentile":258.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"182","median_amount":321.38,"10th_percentile":172.67,"90th_percentile":484.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":196.5,"10th_percentile":20.0,"90th_percentile":258.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20.0,"10th_percentile":20.0,"90th_percentile":20.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"87","median_amount":146.54,"10th_percentile":47.48,"90th_percentile":173.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":142.41,"10th_percentile":142.41,"90th_percentile":200.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"42","median_amount":139.07,"10th_percentile":113.67,"90th_percentile":208.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":462.0,"10th_percentile":451.0,"90th_percentile":1123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"22","median_amount":462.0,"10th_percentile":76.0,"90th_percentile":471.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"116","median_amount":176.33,"10th_percentile":133.89,"90th_percentile":240.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"21","median_amount":316.57,"10th_percentile":20.0,"90th_percentile":322.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":239.7,"10th_percentile":239.7,"90th_percentile":239.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":3830.65,"10th_percentile":3830.65,"90th_percentile":3830.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":390.8,"10th_percentile":390.8,"90th_percentile":390.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1146.08,"10th_percentile":1146.08,"90th_percentile":1146.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":2155.24,"10th_percentile":1566.58,"90th_percentile":2957.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1339.2,"10th_percentile":1339.2,"90th_percentile":1363.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1486.36,"10th_percentile":1431.79,"90th_percentile":1494.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1408.49,"10th_percentile":1408.49,"90th_percentile":1408.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":48947.86,"10th_percentile":48947.86,"90th_percentile":48947.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2232.0,"10th_percentile":2232.0,"90th_percentile":2232.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":5293.81,"10th_percentile":5293.81,"90th_percentile":5293.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1421.08,"10th_percentile":1421.08,"90th_percentile":1421.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2687.49,"10th_percentile":2687.49,"90th_percentile":2687.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"51","median_amount":3830.65,"10th_percentile":3477.58,"90th_percentile":5193.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":2875.19,"10th_percentile":2759.02,"90th_percentile":2875.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5124.81,"10th_percentile":5124.81,"90th_percentile":5124.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3013.38,"10th_percentile":2621.38,"90th_percentile":3115.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2489.33,"10th_percentile":2489.33,"90th_percentile":2561.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":2471.06,"10th_percentile":1415.0,"90th_percentile":5324.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2313.87,"10th_percentile":2280.87,"90th_percentile":3206.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":12514.67,"10th_percentile":12514.67,"90th_percentile":12514.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2877.39,"10th_percentile":2691.04,"90th_percentile":2877.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5054.95,"10th_percentile":5054.95,"90th_percentile":6318.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":8853.2,"10th_percentile":8853.2,"90th_percentile":8853.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"77","median_amount":9102.72,"10th_percentile":7645.95,"90th_percentile":10575.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":6321.69,"10th_percentile":6067.52,"90th_percentile":6324.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3958.94,"10th_percentile":3958.94,"90th_percentile":3958.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":6540.61,"10th_percentile":6271.61,"90th_percentile":6640.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":4471.63,"10th_percentile":4471.63,"90th_percentile":4471.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6266.5,"10th_percentile":6260.7,"90th_percentile":6356.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":3154.06,"10th_percentile":2115.0,"90th_percentile":21313.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2359.93,"10th_percentile":956.0,"90th_percentile":4428.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":7491.54,"10th_percentile":7491.54,"90th_percentile":7491.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":6061.62,"10th_percentile":5953.24,"90th_percentile":6326.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11275.81,"10th_percentile":10988.92,"90th_percentile":11475.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":9749.7,"10th_percentile":9749.7,"90th_percentile":9749.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"72","median_amount":16158.5,"10th_percentile":13918.78,"90th_percentile":17537.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":11248.07,"10th_percentile":11013.19,"90th_percentile":11567.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":11856.76,"10th_percentile":11015.75,"90th_percentile":12052.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11360.81,"10th_percentile":11012.61,"90th_percentile":11459.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":14643.39,"10th_percentile":13428.64,"90th_percentile":49422.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":16662.76,"10th_percentile":10722.42,"90th_percentile":24224.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":19111.7,"10th_percentile":19111.7,"90th_percentile":19111.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":11038.92,"10th_percentile":11014.01,"90th_percentile":11388.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16266.16,"10th_percentile":16266.16,"90th_percentile":16266.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":15975.43,"10th_percentile":15975.43,"90th_percentile":16003.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15610.28,"10th_percentile":15609.68,"90th_percentile":16272.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17087.47,"10th_percentile":16890.37,"90th_percentile":17385.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16109.4,"10th_percentile":16109.4,"90th_percentile":16109.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16273.66,"10th_percentile":16273.66,"90th_percentile":16273.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":3335.34,"10th_percentile":3335.34,"90th_percentile":3335.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":6042.81,"10th_percentile":6042.81,"90th_percentile":6042.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3327.69,"10th_percentile":3327.69,"90th_percentile":3327.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":203.37,"10th_percentile":203.37,"90th_percentile":203.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":4784.11,"10th_percentile":4784.11,"90th_percentile":4784.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2845.03,"10th_percentile":2845.03,"90th_percentile":2845.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1674.0,"10th_percentile":1674.0,"90th_percentile":1674.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":7241.05,"10th_percentile":7241.05,"90th_percentile":8192.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5339.24,"10th_percentile":5339.24,"90th_percentile":5339.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2707.95,"10th_percentile":2707.95,"90th_percentile":2707.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":1632.39,"10th_percentile":1632.39,"90th_percentile":1670.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":530.5,"10th_percentile":530.5,"90th_percentile":995.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":638.04,"10th_percentile":638.04,"90th_percentile":638.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":546.86,"10th_percentile":546.86,"90th_percentile":1306.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1266.23,"10th_percentile":1266.23,"90th_percentile":1374.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":1077.58,"10th_percentile":1077.58,"90th_percentile":1077.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1331.49,"10th_percentile":1331.49,"90th_percentile":1379.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1442.73,"10th_percentile":1442.73,"90th_percentile":1442.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1223.09,"10th_percentile":1223.09,"90th_percentile":1223.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":2793.1,"10th_percentile":2793.1,"90th_percentile":2793.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1563.8,"10th_percentile":1563.8,"90th_percentile":1563.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1374.03,"10th_percentile":1374.03,"90th_percentile":1374.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2227.2,"10th_percentile":2227.2,"90th_percentile":2227.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":5349.65,"10th_percentile":5349.65,"90th_percentile":5349.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"27","median_amount":3764.09,"10th_percentile":2998.9,"90th_percentile":6045.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2725.23,"10th_percentile":2654.91,"90th_percentile":5043.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2651.51,"10th_percentile":2634.09,"90th_percentile":2929.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2840.81,"10th_percentile":2840.81,"90th_percentile":2840.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2759.15,"10th_percentile":2558.15,"90th_percentile":2767.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":3088.15,"10th_percentile":3088.15,"90th_percentile":3088.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2697.6,"10th_percentile":2697.6,"90th_percentile":2697.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2678.23,"10th_percentile":2391.99,"90th_percentile":5043.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":6645.4,"10th_percentile":6645.4,"90th_percentile":6906.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4592.76,"10th_percentile":4592.76,"90th_percentile":4592.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5026.36,"10th_percentile":4959.36,"90th_percentile":10532.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4814.98,"10th_percentile":4814.98,"90th_percentile":4814.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4781.39,"10th_percentile":4781.39,"90th_percentile":4788.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"12","median_amount":2472.54,"10th_percentile":2275.95,"90th_percentile":2850.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":4314.79,"10th_percentile":4314.79,"90th_percentile":6631.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"199","median_amount":4033.92,"10th_percentile":3468.43,"90th_percentile":4665.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"105","median_amount":2850.24,"10th_percentile":2714.0,"90th_percentile":2903.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5225.4,"10th_percentile":5225.4,"90th_percentile":5225.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":2864.69,"10th_percentile":325.46,"90th_percentile":2993.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":10108.89,"10th_percentile":10054.37,"90th_percentile":10112.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":10670.85,"10th_percentile":10670.85,"90th_percentile":10670.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2903.0,"10th_percentile":2664.39,"90th_percentile":2903.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"39","median_amount":2819.49,"10th_percentile":2561.69,"90th_percentile":2828.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"11","median_amount":3748.0,"10th_percentile":1811.33,"90th_percentile":11206.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"15","median_amount":2669.39,"10th_percentile":2030.25,"90th_percentile":3149.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":4431.0,"10th_percentile":4431.0,"90th_percentile":4431.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":18524.65,"10th_percentile":18524.65,"90th_percentile":19227.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":2736.7,"10th_percentile":2452.94,"90th_percentile":2852.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":16802.73,"10th_percentile":16802.73,"90th_percentile":16802.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5048.94,"10th_percentile":4840.87,"90th_percentile":5191.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4956.11,"10th_percentile":4956.11,"90th_percentile":4956.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":5329.21,"10th_percentile":5329.21,"90th_percentile":5329.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10041.64,"10th_percentile":10041.64,"90th_percentile":10356.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":20749.27,"10th_percentile":20749.27,"90th_percentile":20749.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"42","median_amount":16753.73,"10th_percentile":13810.95,"90th_percentile":21860.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":10036.73,"10th_percentile":9358.64,"90th_percentile":12185.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":10538.27,"10th_percentile":10351.37,"90th_percentile":12754.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":28588.16,"10th_percentile":28588.16,"90th_percentile":28588.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10030.83,"10th_percentile":10030.83,"90th_percentile":10030.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9935.72,"10th_percentile":9783.52,"90th_percentile":17948.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":29090.64,"10th_percentile":29090.64,"90th_percentile":29817.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":45104.31,"10th_percentile":20803.14,"90th_percentile":48445.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":65707.46,"10th_percentile":65707.46,"90th_percentile":77346.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12384.23,"10th_percentile":10038.33,"90th_percentile":16759.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15613.38,"10th_percentile":15613.38,"90th_percentile":15613.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":37394.08,"10th_percentile":14765.44,"90th_percentile":37576.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14583.23,"10th_percentile":14583.23,"90th_percentile":14583.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16474.35,"10th_percentile":16474.35,"90th_percentile":16474.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15681.17,"10th_percentile":15681.17,"90th_percentile":15681.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":28005.0,"10th_percentile":28005.0,"90th_percentile":28005.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6655.34,"10th_percentile":6655.34,"90th_percentile":6655.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6848.72,"10th_percentile":6848.72,"90th_percentile":6848.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21704.53,"10th_percentile":21704.53,"90th_percentile":21704.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":17474.35,"10th_percentile":17474.35,"90th_percentile":17474.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"42","median_amount":28005.0,"10th_percentile":26935.22,"90th_percentile":28050.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":21702.03,"10th_percentile":19750.51,"90th_percentile":21704.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":39205.37,"10th_percentile":39205.37,"90th_percentile":39205.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22494.88,"10th_percentile":19751.51,"90th_percentile":22789.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":19646.06,"10th_percentile":19646.06,"90th_percentile":19646.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21940.93,"10th_percentile":21940.93,"90th_percentile":21940.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21485.04,"10th_percentile":21485.04,"90th_percentile":21494.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17713.5,"10th_percentile":17713.5,"90th_percentile":17713.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":40445.34,"10th_percentile":40445.34,"90th_percentile":40445.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":26960.46,"10th_percentile":26960.46,"90th_percentile":44123.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":1589.29,"10th_percentile":1589.29,"90th_percentile":1589.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20823.73,"10th_percentile":20448.73,"90th_percentile":20823.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Pacemaker and Similar Procedures","code_information":[{"code":"5221","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":11994.55,"10th_percentile":11994.55,"90th_percentile":11994.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":15677.28,"10th_percentile":15677.28,"90th_percentile":15677.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7326.08,"10th_percentile":7326.08,"90th_percentile":7326.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6928.18,"10th_percentile":6928.18,"90th_percentile":6928.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10442.09,"10th_percentile":10442.09,"90th_percentile":10442.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"18","median_amount":14221.38,"10th_percentile":13952.79,"90th_percentile":21670.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":9676.63,"10th_percentile":9621.77,"90th_percentile":10195.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9756.97,"10th_percentile":8981.08,"90th_percentile":10513.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9948.63,"10th_percentile":9948.63,"90th_percentile":16868.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9276.0,"10th_percentile":9276.0,"90th_percentile":9289.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7556.47,"10th_percentile":7556.47,"90th_percentile":7556.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":32436.53,"10th_percentile":32436.53,"90th_percentile":32436.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":38585.24,"10th_percentile":38585.24,"90th_percentile":38585.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9666.54,"10th_percentile":9264.18,"90th_percentile":16876.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13494.89,"10th_percentile":13494.89,"90th_percentile":13494.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16874.51,"10th_percentile":16874.51,"90th_percentile":17212.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17717.94,"10th_percentile":17717.94,"90th_percentile":17717.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":32984.71,"10th_percentile":32984.71,"90th_percentile":32984.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16876.11,"10th_percentile":16876.11,"90th_percentile":16876.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":41509.37,"10th_percentile":41509.37,"90th_percentile":41509.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19859.75,"10th_percentile":19859.75,"90th_percentile":19859.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20852.44,"10th_percentile":20852.44,"90th_percentile":20852.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22687.0,"10th_percentile":22687.0,"90th_percentile":28364.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"14","median_amount":42639.89,"10th_percentile":42202.89,"90th_percentile":42783.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28169.65,"10th_percentile":27210.9,"90th_percentile":28364.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29782.59,"10th_percentile":29776.69,"90th_percentile":41406.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28358.75,"10th_percentile":28358.75,"90th_percentile":28937.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28082.17,"10th_percentile":28082.17,"90th_percentile":28082.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":79528.75,"10th_percentile":79528.75,"90th_percentile":79528.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":58319.25,"10th_percentile":58277.25,"90th_percentile":78620.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":256229.02,"10th_percentile":256229.02,"90th_percentile":256229.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27991.25,"10th_percentile":27991.25,"90th_percentile":28358.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2772.18,"10th_percentile":2772.18,"90th_percentile":2772.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"20","median_amount":1043.68,"10th_percentile":1023.97,"90th_percentile":1809.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":1345.04,"10th_percentile":789.56,"90th_percentile":1610.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1580.3,"10th_percentile":1580.3,"90th_percentile":1580.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1532.96,"10th_percentile":1459.58,"90th_percentile":6822.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":960.91,"10th_percentile":960.91,"90th_percentile":960.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":980.93,"10th_percentile":935.41,"90th_percentile":1111.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1473.92,"10th_percentile":1473.92,"90th_percentile":1473.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":559.0,"10th_percentile":559.0,"90th_percentile":559.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":754.0,"10th_percentile":754.0,"90th_percentile":754.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1218.44,"10th_percentile":1218.44,"90th_percentile":2411.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"24","median_amount":1492.55,"10th_percentile":1116.41,"90th_percentile":2039.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1358.47,"10th_percentile":1320.15,"90th_percentile":1952.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1317.77,"10th_percentile":1317.77,"90th_percentile":1317.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":506.64,"10th_percentile":506.64,"90th_percentile":506.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":826.19,"10th_percentile":607.99,"90th_percentile":957.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"31","median_amount":2429.0,"10th_percentile":1951.86,"90th_percentile":2429.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"37","median_amount":1754.0,"10th_percentile":1702.8,"90th_percentile":1754.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":829.28,"10th_percentile":795.54,"90th_percentile":961.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":781.76,"10th_percentile":781.76,"90th_percentile":781.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":846.73,"10th_percentile":846.73,"90th_percentile":846.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":775.35,"10th_percentile":775.35,"90th_percentile":775.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":1986.77,"10th_percentile":1986.77,"90th_percentile":1986.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1433.0,"10th_percentile":1433.0,"90th_percentile":1433.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":2524.21,"10th_percentile":1563.62,"90th_percentile":2672.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1317.03,"10th_percentile":1317.03,"90th_percentile":1317.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"19","median_amount":3241.92,"10th_percentile":2216.73,"90th_percentile":3850.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2449.23,"10th_percentile":2449.23,"90th_percentile":2493.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":3093.32,"10th_percentile":3093.32,"90th_percentile":3094.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2364.2,"10th_percentile":2234.04,"90th_percentile":2992.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2497.19,"10th_percentile":2497.19,"90th_percentile":2497.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":4011.59,"10th_percentile":4011.59,"90th_percentile":4011.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"18","median_amount":7522.64,"10th_percentile":6133.96,"90th_percentile":9475.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3127.39,"10th_percentile":3055.6,"90th_percentile":3386.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3283.46,"10th_percentile":3283.46,"90th_percentile":3283.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":6102.2,"10th_percentile":6102.2,"90th_percentile":6102.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3095.47,"10th_percentile":3095.47,"90th_percentile":3095.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":4049.87,"10th_percentile":4049.87,"90th_percentile":4049.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":5263.61,"10th_percentile":5263.61,"90th_percentile":5263.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3128.99,"10th_percentile":3128.99,"90th_percentile":5051.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":9137.09,"10th_percentile":9137.09,"90th_percentile":9137.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"21","median_amount":7667.45,"10th_percentile":7467.45,"90th_percentile":10668.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5525.01,"10th_percentile":5300.48,"90th_percentile":5631.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10251.84,"10th_percentile":10251.84,"90th_percentile":10251.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5526.61,"10th_percentile":5526.61,"90th_percentile":5526.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5469.12,"10th_percentile":5469.12,"90th_percentile":5469.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":3627.32,"10th_percentile":3627.32,"90th_percentile":3627.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2730.75,"10th_percentile":2617.75,"90th_percentile":2732.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5519.11,"10th_percentile":5519.11,"90th_percentile":5519.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4788.14,"10th_percentile":4128.44,"90th_percentile":5173.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":5850.72,"10th_percentile":5850.72,"90th_percentile":5850.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"168","median_amount":6001.99,"10th_percentile":5606.25,"90th_percentile":9545.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":5163.54,"10th_percentile":4894.94,"90th_percentile":5265.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8490.26,"10th_percentile":8490.26,"90th_percentile":8490.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":5325.47,"10th_percentile":5126.57,"90th_percentile":5425.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":5958.85,"10th_percentile":5895.9,"90th_percentile":6422.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5265.86,"10th_percentile":5265.86,"90th_percentile":5265.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5114.14,"10th_percentile":4845.56,"90th_percentile":5458.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"16","median_amount":4348.6,"10th_percentile":4014.38,"90th_percentile":12456.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"17","median_amount":2752.0,"10th_percentile":2390.29,"90th_percentile":3129.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":5462.0,"10th_percentile":4802.7,"90th_percentile":7269.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":4958.09,"10th_percentile":4802.54,"90th_percentile":5168.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":7356.46,"10th_percentile":6736.2,"90th_percentile":8976.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9214.71,"10th_percentile":9011.74,"90th_percentile":9214.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9669.26,"10th_percentile":9669.26,"90th_percentile":9669.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9216.31,"10th_percentile":9216.31,"90th_percentile":9216.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":205.48,"10th_percentile":205.48,"90th_percentile":205.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":2674.02,"10th_percentile":2674.02,"90th_percentile":2674.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":405.8,"10th_percentile":405.8,"90th_percentile":405.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":602.43,"10th_percentile":602.43,"90th_percentile":602.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":590.38,"10th_percentile":590.38,"90th_percentile":590.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1817.42,"10th_percentile":1817.42,"90th_percentile":1817.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"16","median_amount":2674.02,"10th_percentile":2623.52,"90th_percentile":3364.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1814.92,"10th_percentile":1698.26,"90th_percentile":1817.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1600.26,"10th_percentile":1600.26,"90th_percentile":1613.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1848.9,"10th_percentile":1848.9,"90th_percentile":1848.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1804.8,"10th_percentile":1799.0,"90th_percentile":1959.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":1294.25,"10th_percentile":1294.25,"90th_percentile":1294.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1857.0,"10th_percentile":1857.0,"90th_percentile":1857.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":1940.03,"10th_percentile":1940.03,"90th_percentile":1940.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1444.42,"10th_percentile":1444.42,"90th_percentile":1444.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2989.84,"10th_percentile":2440.51,"90th_percentile":3056.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":3006.22,"10th_percentile":3006.22,"90th_percentile":3347.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"51","median_amount":4334.49,"10th_percentile":2674.02,"90th_percentile":5041.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":2933.9,"10th_percentile":2903.22,"90th_percentile":3056.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3203.18,"10th_percentile":3078.76,"90th_percentile":3205.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":6752.86,"10th_percentile":6752.86,"90th_percentile":6752.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3025.33,"10th_percentile":3025.33,"90th_percentile":3027.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2490.32,"10th_percentile":2490.32,"90th_percentile":2490.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":5896.32,"10th_percentile":4330.51,"90th_percentile":7280.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2247.6,"10th_percentile":2202.0,"90th_percentile":3348.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":5517.16,"10th_percentile":5517.16,"90th_percentile":8403.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2934.03,"10th_percentile":2903.82,"90th_percentile":3058.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3486.26,"10th_percentile":3486.26,"90th_percentile":3597.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":4113.31,"10th_percentile":4113.31,"90th_percentile":4113.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"43","median_amount":7084.07,"10th_percentile":6734.07,"90th_percentile":8167.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":4502.4,"10th_percentile":4318.87,"90th_percentile":4589.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7384.11,"10th_percentile":7384.11,"90th_percentile":8258.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4507.23,"10th_percentile":4329.33,"90th_percentile":4728.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":7103.52,"10th_percentile":7103.52,"90th_percentile":7103.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4454.54,"10th_percentile":4454.06,"90th_percentile":4460.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":3095.12,"10th_percentile":3073.4,"90th_percentile":3806.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2709.32,"10th_percentile":2709.2,"90th_percentile":4060.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":580.96,"10th_percentile":580.96,"90th_percentile":580.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":7900.66,"10th_percentile":7900.66,"90th_percentile":7900.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1974.45,"10th_percentile":1974.45,"90th_percentile":1974.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2247.6,"10th_percentile":2247.6,"90th_percentile":2247.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"12","median_amount":2356.99,"10th_percentile":2347.59,"90th_percentile":2356.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1733.14,"10th_percentile":1732.54,"90th_percentile":1772.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1813.6,"10th_percentile":1727.24,"90th_percentile":1819.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":1801.0,"10th_percentile":1801.0,"90th_percentile":1801.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1596.16,"10th_percentile":1596.16,"90th_percentile":1596.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":3126.41,"10th_percentile":3126.41,"90th_percentile":10287.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":2776.0,"10th_percentile":2232.0,"90th_percentile":3109.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1610.71,"10th_percentile":1610.71,"90th_percentile":1610.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":212.64,"10th_percentile":212.64,"90th_percentile":212.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"21","median_amount":412.17,"10th_percentile":410.95,"90th_percentile":848.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":271.19,"10th_percentile":240.0,"90th_percentile":466.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28.95,"10th_percentile":28.95,"90th_percentile":246.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":520.02,"10th_percentile":520.02,"90th_percentile":520.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":1323.0,"10th_percentile":1323.0,"90th_percentile":1323.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1334.0,"10th_percentile":1334.0,"90th_percentile":1334.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":265.8,"10th_percentile":265.41,"90th_percentile":584.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":1465.78,"10th_percentile":1465.78,"90th_percentile":2125.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1172.62,"10th_percentile":1172.62,"90th_percentile":1172.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":990.94,"10th_percentile":990.94,"90th_percentile":990.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1199.75,"10th_percentile":1199.75,"90th_percentile":1199.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":320.44,"10th_percentile":320.44,"90th_percentile":320.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":3683.16,"10th_percentile":3683.16,"90th_percentile":3683.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1920.6,"10th_percentile":1920.6,"90th_percentile":2398.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":294.72,"10th_percentile":294.72,"90th_percentile":294.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"33","median_amount":69.08,"10th_percentile":47.0,"90th_percentile":163.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"21","median_amount":249.0,"10th_percentile":121.32,"90th_percentile":984.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"517","median_amount":98.1,"10th_percentile":96.0,"90th_percentile":319.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"149","median_amount":77.09,"10th_percentile":58.28,"90th_percentile":166.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":136.13,"10th_percentile":130.52,"90th_percentile":335.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"106","median_amount":82.07,"10th_percentile":60.44,"90th_percentile":171.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"11","median_amount":158.28,"10th_percentile":43.0,"90th_percentile":158.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":79.47,"10th_percentile":4.47,"90th_percentile":166.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"44","median_amount":78.68,"10th_percentile":76.32,"90th_percentile":162.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"47","median_amount":237.37,"10th_percentile":72.81,"90th_percentile":630.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"70","median_amount":68.15,"10th_percentile":49.15,"90th_percentile":213.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":237.37,"10th_percentile":163.63,"90th_percentile":727.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"13","median_amount":553.59,"10th_percentile":325.38,"90th_percentile":1756.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"90","median_amount":77.88,"10th_percentile":63.18,"90th_percentile":182.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":2178.1,"10th_percentile":2178.1,"90th_percentile":2178.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":3269.04,"10th_percentile":3269.04,"90th_percentile":3269.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"164","median_amount":94.06,"10th_percentile":75.24,"90th_percentile":190.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"42","median_amount":226.68,"10th_percentile":111.78,"90th_percentile":851.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1840","median_amount":189.55,"10th_percentile":130.1,"90th_percentile":370.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"858","median_amount":94.46,"10th_percentile":90.23,"90th_percentile":193.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":165.57,"10th_percentile":129.57,"90th_percentile":349.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"503","median_amount":98.76,"10th_percentile":91.4,"90th_percentile":199.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"56","median_amount":188.84,"10th_percentile":109.36,"90th_percentile":351.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":271.96,"10th_percentile":271.96,"90th_percentile":600.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"99","median_amount":95.98,"10th_percentile":93.27,"90th_percentile":194.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"237","median_amount":95.0,"10th_percentile":91.15,"90th_percentile":270.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":400.0,"10th_percentile":400.0,"90th_percentile":1611.0},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"154","median_amount":99.0,"10th_percentile":72.81,"90th_percentile":793.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"211","median_amount":90.02,"10th_percentile":65.53,"90th_percentile":264.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":768.9,"10th_percentile":680.84,"90th_percentile":6825.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"46","median_amount":897.79,"10th_percentile":523.25,"90th_percentile":2598.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"419","median_amount":94.06,"10th_percentile":90.23,"90th_percentile":250.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":1361.57,"10th_percentile":1361.57,"90th_percentile":1361.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"60","median_amount":213.81,"10th_percentile":162.97,"90th_percentile":364.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"12","median_amount":843.97,"10th_percentile":404.28,"90th_percentile":1677.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"758","median_amount":436.33,"10th_percentile":277.32,"90th_percentile":602.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"257","median_amount":216.31,"10th_percentile":205.22,"90th_percentile":410.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":422.77,"10th_percentile":374.18,"90th_percentile":683.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"149","median_amount":226.5,"10th_percentile":171.13,"90th_percentile":407.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":336.54,"10th_percentile":134.0,"90th_percentile":902.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":855.8,"10th_percentile":855.8,"90th_percentile":855.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":218.17,"10th_percentile":18.17,"90th_percentile":487.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"95","median_amount":215.99,"10th_percentile":202.51,"90th_percentile":390.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":174.54,"10th_percentile":167.43,"90th_percentile":227.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"70","median_amount":780.0,"10th_percentile":207.12,"90th_percentile":3848.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"118","median_amount":191.81,"10th_percentile":146.81,"90th_percentile":896.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":1524.07,"10th_percentile":150.0,"90th_percentile":2187.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"14","median_amount":2615.43,"10th_percentile":2026.28,"90th_percentile":5890.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"143","median_amount":213.81,"10th_percentile":135.81,"90th_percentile":431.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":486.87,"10th_percentile":391.87,"90th_percentile":562.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":856.78,"10th_percentile":856.78,"90th_percentile":856.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"131","median_amount":829.35,"10th_percentile":528.11,"90th_percentile":1111.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"53","median_amount":608.42,"10th_percentile":465.25,"90th_percentile":780.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":509.22,"10th_percentile":219.01,"90th_percentile":680.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":265.5,"10th_percentile":265.5,"90th_percentile":1207.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":494.87,"10th_percentile":468.01,"90th_percentile":574.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":481.32,"10th_percentile":455.26,"90th_percentile":699.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":623.0,"10th_percentile":109.91,"90th_percentile":10361.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"15","median_amount":450.0,"10th_percentile":134.0,"90th_percentile":984.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":2269.32,"10th_percentile":2269.32,"90th_percentile":2269.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":3396.52,"10th_percentile":3396.52,"90th_percentile":3396.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":485.47,"10th_percentile":458.65,"90th_percentile":800.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"25","median_amount":153.38,"10th_percentile":100.0,"90th_percentile":307.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":985.45,"10th_percentile":560.6,"90th_percentile":3158.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"542","median_amount":541.5,"10th_percentile":206.85,"90th_percentile":666.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"208","median_amount":156.82,"10th_percentile":150.62,"90th_percentile":384.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":274.45,"10th_percentile":218.85,"90th_percentile":1148.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"105","median_amount":167.33,"10th_percentile":122.6,"90th_percentile":406.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"13","median_amount":280.41,"10th_percentile":224.33,"90th_percentile":555.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":160.67,"10th_percentile":155.87,"90th_percentile":392.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"65","median_amount":159.06,"10th_percentile":130.0,"90th_percentile":382.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":128.54,"10th_percentile":128.54,"90th_percentile":128.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"50","median_amount":205.31,"10th_percentile":160.7,"90th_percentile":1099.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"38","median_amount":148.78,"10th_percentile":108.47,"90th_percentile":442.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":4311.13,"10th_percentile":1811.59,"90th_percentile":8586.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"101","median_amount":200.0,"10th_percentile":152.75,"90th_percentile":384.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"1 through 10","median_amount":4648.14,"10th_percentile":4648.14,"90th_percentile":4648.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":321.88,"10th_percentile":321.88,"90th_percentile":321.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"74","median_amount":317.17,"10th_percentile":177.62,"90th_percentile":472.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"32","median_amount":1546.83,"10th_percentile":831.42,"90th_percentile":2708.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1164","median_amount":662.95,"10th_percentile":522.07,"90th_percentile":862.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"388","median_amount":315.25,"10th_percentile":300.83,"90th_percentile":402.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":580.19,"10th_percentile":350.09,"90th_percentile":1968.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"175","median_amount":333.68,"10th_percentile":265.34,"90th_percentile":532.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"31","median_amount":314.27,"10th_percentile":168.97,"90th_percentile":898.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":449.0,"10th_percentile":281.0,"90th_percentile":880.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":322.33,"10th_percentile":147.33,"90th_percentile":571.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"111","median_amount":318.73,"10th_percentile":165.0,"90th_percentile":580.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"82","median_amount":335.92,"10th_percentile":303.26,"90th_percentile":4169.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"90","median_amount":298.18,"10th_percentile":140.92,"90th_percentile":521.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":2062.11,"10th_percentile":335.92,"90th_percentile":3079.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"27","median_amount":4427.51,"10th_percentile":2220.3,"90th_percentile":8141.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"167","median_amount":319.88,"10th_percentile":270.72,"90th_percentile":594.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1094.53,"10th_percentile":788.31,"90th_percentile":2431.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"31","median_amount":1298.56,"10th_percentile":727.72,"90th_percentile":1490.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1089.58,"10th_percentile":883.24,"90th_percentile":2542.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1029.09,"10th_percentile":672.56,"90th_percentile":2472.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1953.13,"10th_percentile":1953.13,"90th_percentile":1953.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1017.69,"10th_percentile":766.83,"90th_percentile":2526.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":3285.49,"10th_percentile":3285.49,"90th_percentile":3628.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1036.58,"10th_percentile":1036.58,"90th_percentile":1036.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":3301.65,"10th_percentile":3301.65,"90th_percentile":3301.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":985.38,"10th_percentile":985.38,"90th_percentile":990.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":344.39,"10th_percentile":284.34,"90th_percentile":677.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":671.26,"10th_percentile":671.26,"90th_percentile":671.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"139","median_amount":657.52,"10th_percentile":644.96,"90th_percentile":1083.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":362.68,"10th_percentile":343.46,"90th_percentile":670.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":375.19,"10th_percentile":344.89,"90th_percentile":608.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":657.52,"10th_percentile":657.52,"90th_percentile":657.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":362.68,"10th_percentile":254.89,"90th_percentile":565.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":359.05,"10th_percentile":183.16,"90th_percentile":739.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":350.0,"10th_percentile":271.53,"90th_percentile":2498.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":309.1,"10th_percentile":229.1,"90th_percentile":500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":1375.34,"10th_percentile":1375.34,"90th_percentile":1375.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":1627.9,"10th_percentile":1627.9,"90th_percentile":3095.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":355.43,"10th_percentile":221.96,"90th_percentile":671.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":576.16,"10th_percentile":482.1,"90th_percentile":579.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":1058.28,"10th_percentile":1058.28,"90th_percentile":1058.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"158","median_amount":657.52,"10th_percentile":591.77,"90th_percentile":860.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":541.07,"10th_percentile":457.14,"90th_percentile":675.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":576.31,"10th_percentile":399.93,"90th_percentile":601.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":834.89,"10th_percentile":834.89,"90th_percentile":834.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":339.5,"10th_percentile":339.5,"90th_percentile":339.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":458.54,"10th_percentile":458.54,"90th_percentile":458.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":573.85,"10th_percentile":573.85,"90th_percentile":574.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"14","median_amount":575.37,"10th_percentile":440.46,"90th_percentile":3914.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":331.2,"10th_percentile":109.85,"90th_percentile":431.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":396.41,"10th_percentile":396.41,"90th_percentile":396.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":4850.85,"10th_percentile":4458.22,"90th_percentile":5147.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":451.37,"10th_percentile":449.37,"90th_percentile":480.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1295.82,"10th_percentile":1295.82,"90th_percentile":1429.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":1617.24,"10th_percentile":1617.24,"90th_percentile":1617.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"22","median_amount":1939.5,"10th_percentile":1621.15,"90th_percentile":2856.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1245.34,"10th_percentile":1118.84,"90th_percentile":1663.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1214.44,"10th_percentile":1132.53,"90th_percentile":1953.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":3050.92,"10th_percentile":3050.92,"90th_percentile":3050.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1204.62,"10th_percentile":1204.62,"90th_percentile":1204.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1157.56,"10th_percentile":1150.11,"90th_percentile":3000.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":8170.63,"10th_percentile":8170.63,"90th_percentile":8170.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1360.15,"10th_percentile":734.9,"90th_percentile":1879.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1180.53,"10th_percentile":1154.7,"90th_percentile":1232.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"13","median_amount":1295.4,"10th_percentile":1290.13,"90th_percentile":1305.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":3712.8,"10th_percentile":2219.28,"90th_percentile":3835.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"109","median_amount":2243.53,"10th_percentile":2001.15,"90th_percentile":2625.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"70","median_amount":1293.63,"10th_percentile":1241.15,"90th_percentile":1544.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2409.63,"10th_percentile":2409.63,"90th_percentile":2409.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":1302.66,"10th_percentile":1240.79,"90th_percentile":1359.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":1596.0,"10th_percentile":1596.0,"90th_percentile":1596.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1316.46,"10th_percentile":1016.46,"90th_percentile":1638.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1283.23,"10th_percentile":1193.65,"90th_percentile":1452.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1053.17,"10th_percentile":1053.17,"90th_percentile":1053.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":1332.31,"10th_percentile":1332.31,"90th_percentile":1663.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1199.08,"10th_percentile":1049.08,"90th_percentile":1249.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":9602.27,"10th_percentile":9079.02,"90th_percentile":10526.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":1294.13,"10th_percentile":1094.13,"90th_percentile":1395.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapeutic Nuclear Medicine","code_information":[{"code":"5661","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":130.0,"10th_percentile":130.0,"90th_percentile":130.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. 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Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":298.58,"10th_percentile":298.58,"90th_percentile":303.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":96.97,"10th_percentile":96.97,"90th_percentile":313.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":318.18,"10th_percentile":318.18,"90th_percentile":318.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":320.49,"10th_percentile":320.49,"90th_percentile":320.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":314.99,"10th_percentile":314.99,"90th_percentile":314.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":540.18,"10th_percentile":540.18,"90th_percentile":540.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":1270.31,"10th_percentile":1270.31,"90th_percentile":1270.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2403.13,"10th_percentile":2403.13,"90th_percentile":2403.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1686.0,"10th_percentile":1686.0,"90th_percentile":1686.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":516.53,"10th_percentile":516.53,"90th_percentile":516.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":553.55,"10th_percentile":553.55,"90th_percentile":553.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":483.0,"10th_percentile":483.0,"90th_percentile":483.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":97.29,"10th_percentile":77.83,"90th_percentile":718.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":198.16,"10th_percentile":182.42,"90th_percentile":421.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":191.54,"10th_percentile":102.58,"90th_percentile":233.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":862.07,"10th_percentile":862.07,"90th_percentile":862.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":293.0,"10th_percentile":293.0,"90th_percentile":293.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":145.3,"10th_percentile":145.3,"90th_percentile":145.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":187.5,"10th_percentile":187.5,"90th_percentile":187.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":275.44,"10th_percentile":260.95,"90th_percentile":485.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"85","median_amount":437.88,"10th_percentile":249.51,"90th_percentile":589.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":275.44,"10th_percentile":260.95,"90th_percentile":469.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":295.11,"10th_percentile":266.28,"90th_percentile":498.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":1754.23,"10th_percentile":1754.23,"90th_percentile":1754.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":281.06,"10th_percentile":281.06,"90th_percentile":499.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":273.8,"10th_percentile":272.68,"90th_percentile":488.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":876.5,"10th_percentile":173.16,"90th_percentile":3922.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"15","median_amount":579.5,"10th_percentile":462.75,"90th_percentile":1803.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":4533.95,"10th_percentile":4533.95,"90th_percentile":4533.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":342.25,"10th_percentile":265.23,"90th_percentile":574.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":3084.6,"10th_percentile":3084.6,"90th_percentile":3084.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"59","median_amount":287.14,"10th_percentile":153.35,"90th_percentile":467.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":469.32,"10th_percentile":450.22,"90th_percentile":657.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":666.51,"10th_percentile":666.51,"90th_percentile":666.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":489.23,"10th_percentile":489.23,"90th_percentile":489.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":4656.0,"10th_percentile":4656.0,"90th_percentile":4656.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":454.7,"10th_percentile":454.7,"90th_percentile":454.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":441.75,"10th_percentile":441.75,"90th_percentile":508.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"12","median_amount":981.0,"10th_percentile":469.63,"90th_percentile":1370.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":717.0,"10th_percentile":717.0,"90th_percentile":717.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":1951.97,"10th_percentile":1951.97,"90th_percentile":2924.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":470.82,"10th_percentile":451.72,"90th_percentile":522.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":51.4,"10th_percentile":51.4,"90th_percentile":51.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21.66,"10th_percentile":21.66,"90th_percentile":21.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"14","median_amount":358.68,"10th_percentile":127.17,"90th_percentile":422.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":266.72,"10th_percentile":33.3,"90th_percentile":333.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":72.92,"10th_percentile":72.92,"90th_percentile":79.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":59.12,"10th_percentile":44.34,"90th_percentile":67.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":268.8,"10th_percentile":105.06,"90th_percentile":375.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":315.24,"10th_percentile":50.85,"90th_percentile":472.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"36","median_amount":100.15,"10th_percentile":40.16,"90th_percentile":167.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":158.51,"10th_percentile":72.54,"90th_percentile":536.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":170.96,"10th_percentile":55.16,"90th_percentile":362.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":179.73,"10th_percentile":179.73,"90th_percentile":179.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":53.61,"10th_percentile":53.61,"90th_percentile":53.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":261.55,"10th_percentile":104.62,"90th_percentile":364.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":315.24,"10th_percentile":52.54,"90th_percentile":420.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"19","median_amount":94.41,"10th_percentile":87.5,"90th_percentile":114.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":561.84,"10th_percentile":561.84,"90th_percentile":561.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"96","median_amount":52.12,"10th_percentile":47.13,"90th_percentile":114.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"84","median_amount":114.01,"10th_percentile":108.37,"90th_percentile":114.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":119.72,"10th_percentile":106.2,"90th_percentile":119.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":108.37,"10th_percentile":108.37,"90th_percentile":108.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":112.88,"10th_percentile":73.68,"90th_percentile":113.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":60.03,"10th_percentile":55.44,"90th_percentile":798.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":35.93,"10th_percentile":34.23,"90th_percentile":82.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":1261.06,"10th_percentile":1261.06,"90th_percentile":1261.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":1065.47,"10th_percentile":1065.47,"90th_percentile":1065.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":114.01,"10th_percentile":109.38,"90th_percentile":114.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32.99,"10th_percentile":32.99,"90th_percentile":32.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electronic Analysis of Devices","code_information":[{"code":"5742","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":101.82,"10th_percentile":101.82,"90th_percentile":101.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":223.74,"10th_percentile":200.46,"90th_percentile":671.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":88.92,"10th_percentile":88.92,"90th_percentile":220.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"130","median_amount":192.75,"10th_percentile":38.55,"90th_percentile":424.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"124","median_amount":558.84,"10th_percentile":223.53,"90th_percentile":1229.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":468.52,"10th_percentile":107.13,"90th_percentile":964.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":145.6,"10th_percentile":64.72,"90th_percentile":258.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":68.18,"10th_percentile":68.18,"90th_percentile":68.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":560.5,"10th_percentile":112.1,"90th_percentile":784.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":573.3,"10th_percentile":217.52,"90th_percentile":1105.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":1976.0,"10th_percentile":419.9,"90th_percentile":3211.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1976.0,"10th_percentile":247.0,"90th_percentile":2964.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":580.02,"10th_percentile":106.84,"90th_percentile":893.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1068.11,"10th_percentile":969.15,"90th_percentile":1071.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":1316.24,"10th_percentile":1316.24,"90th_percentile":1316.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"38","median_amount":1902.22,"10th_percentile":1121.78,"90th_percentile":1902.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":1069.08,"10th_percentile":1023.5,"90th_percentile":1099.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1077.43,"10th_percentile":877.87,"90th_percentile":1122.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":1056.14,"10th_percentile":578.93,"90th_percentile":1058.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"1 through 10","median_amount":1984.0,"10th_percentile":1984.0,"90th_percentile":1984.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":1416.75,"10th_percentile":1416.75,"90th_percentile":1658.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":3533.86,"10th_percentile":3533.86,"90th_percentile":3533.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1026.01,"10th_percentile":696.28,"90th_percentile":1071.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inj, bupivacaine, nos, 0.5mg","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":70.75,"10th_percentile":70.75,"90th_percentile":70.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, nitroglycerin, 5 mg","code_information":[{"code":"9404","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28.75,"10th_percentile":28.75,"90th_percentile":28.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"1 through 10","median_amount":1429.43,"10th_percentile":1429.43,"90th_percentile":1604.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":991.75,"10th_percentile":844.56,"90th_percentile":1743.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1653.46,"10th_percentile":1653.46,"90th_percentile":1775.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"32","median_amount":113.98,"10th_percentile":91.19,"90th_percentile":114.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"259","median_amount":247.51,"10th_percentile":43.63,"90th_percentile":291.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"183","median_amount":113.98,"10th_percentile":109.35,"90th_percentile":129.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"56","median_amount":113.98,"10th_percentile":20.0,"90th_percentile":119.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"13","median_amount":20.0,"10th_percentile":20.0,"90th_percentile":20.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":91.31,"10th_percentile":90.3,"90th_percentile":116.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"63","median_amount":112.85,"10th_percentile":108.8,"90th_percentile":132.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"16","median_amount":120.17,"10th_percentile":118.7,"90th_percentile":348.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"27","median_amount":86.72,"10th_percentile":65.04,"90th_percentile":126.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"16","median_amount":250.63,"10th_percentile":250.63,"90th_percentile":303.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"68","median_amount":113.98,"10th_percentile":109.35,"90th_percentile":138.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"1 through 10","median_amount":26.69,"10th_percentile":26.69,"90th_percentile":26.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"50","median_amount":21.79,"10th_percentile":7.65,"90th_percentile":80.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":28.36,"10th_percentile":25.2,"90th_percentile":99.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"400","median_amount":22.73,"10th_percentile":6.35,"90th_percentile":65.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"219","median_amount":17.81,"10th_percentile":8.01,"90th_percentile":42.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":39.95,"10th_percentile":39.95,"90th_percentile":46.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"97","median_amount":14.25,"10th_percentile":8.0,"90th_percentile":48.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"15","median_amount":24.34,"10th_percentile":8.18,"90th_percentile":28.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":5.91,"10th_percentile":5.91,"90th_percentile":5.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":8.68,"10th_percentile":4.76,"90th_percentile":21.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"67","median_amount":16.52,"10th_percentile":8.25,"90th_percentile":41.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":10.0,"10th_percentile":10.0,"90th_percentile":10.0},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":0.23,"10th_percentile":0.23,"90th_percentile":0.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"54","median_amount":544.0,"10th_percentile":11.68,"90th_percentile":1641.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"14","median_amount":21.48,"10th_percentile":8.72,"90th_percentile":37.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":451.86,"10th_percentile":6.98,"90th_percentile":1192.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"25","median_amount":570.44,"10th_percentile":161.78,"90th_percentile":1861.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"123","median_amount":22.08,"10th_percentile":11.04,"90th_percentile":49.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"13","median_amount":404.6,"10th_percentile":183.69,"90th_percentile":683.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"14","median_amount":332.04,"10th_percentile":105.12,"90th_percentile":777.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"258","median_amount":220.79,"10th_percentile":69.23,"90th_percentile":660.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"130","median_amount":389.51,"10th_percentile":98.29,"90th_percentile":901.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":164.38,"10th_percentile":164.38,"90th_percentile":164.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":316.12,"10th_percentile":98.04,"90th_percentile":697.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":226.8,"10th_percentile":201.6,"90th_percentile":504.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":1056.0,"10th_percentile":792.0,"90th_percentile":1452.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":199.28,"10th_percentile":99.36,"90th_percentile":438.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"42","median_amount":298.75,"10th_percentile":76.07,"90th_percentile":900.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"58","median_amount":1112.0,"10th_percentile":278.0,"90th_percentile":2609.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"15","median_amount":303.0,"10th_percentile":181.0,"90th_percentile":1407.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":326.0,"10th_percentile":195.6,"90th_percentile":574.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":374.98,"10th_percentile":98.77,"90th_percentile":833.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"60","median_amount":96.05,"10th_percentile":76.21,"90th_percentile":98.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"19","median_amount":131.16,"10th_percentile":100.32,"90th_percentile":131.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"691","median_amount":130.1,"10th_percentile":127.65,"90th_percentile":130.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"309","median_amount":96.05,"10th_percentile":96.05,"90th_percentile":98.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":176.42,"10th_percentile":176.42,"90th_percentile":176.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"180","median_amount":100.85,"10th_percentile":80.03,"90th_percentile":155.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"27","median_amount":177.18,"10th_percentile":134.14,"90th_percentile":177.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":186.05,"10th_percentile":177.18,"90th_percentile":186.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":98.01,"10th_percentile":98.01,"90th_percentile":100.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"77","median_amount":95.09,"10th_percentile":95.09,"90th_percentile":97.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":383.03,"10th_percentile":383.03,"90th_percentile":383.03},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"78","median_amount":284.24,"10th_percentile":109.91,"90th_percentile":442.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"99","median_amount":98.92,"10th_percentile":98.92,"90th_percentile":98.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"1 through 10","median_amount":371.62,"10th_percentile":109.91,"90th_percentile":371.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"33","median_amount":460.48,"10th_percentile":352.21,"90th_percentile":460.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"132","median_amount":96.05,"10th_percentile":96.05,"90th_percentile":98.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":200.05,"10th_percentile":100.22,"90th_percentile":206.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"1 through 10","median_amount":832.8,"10th_percentile":832.8,"90th_percentile":832.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"102","median_amount":187.71,"10th_percentile":119.63,"90th_percentile":997.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":125.05,"10th_percentile":85.21,"90th_percentile":588.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":183.38,"10th_percentile":183.38,"90th_percentile":249.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":110.3,"10th_percentile":89.47,"90th_percentile":393.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"1 through 10","median_amount":1020.59,"10th_percentile":1020.59,"90th_percentile":1020.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"1 through 10","median_amount":528.0,"10th_percentile":348.02,"90th_percentile":660.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":86.95,"10th_percentile":86.95,"90th_percentile":86.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":204.0,"10th_percentile":89.71,"90th_percentile":229.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"14","median_amount":1025.78,"10th_percentile":289.34,"90th_percentile":1918.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":148.1,"10th_percentile":50.0,"90th_percentile":177.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":479.44,"10th_percentile":479.44,"90th_percentile":479.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":146.66,"10th_percentile":100.22,"90th_percentile":1249.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"1 through 10","median_amount":295.0,"10th_percentile":295.0,"90th_percentile":295.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Asa Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 46] [Cardiac Cath (%BC): 46] [Observation (%BC): 46] [Emergency Department (%BC): 46] [Occupational Therapy (%BC): 46] [Physical Therapy (%BC): 46] [Respiratory Services/Therapy  (%BC): 46] [Speech Therapy (%BC): 46] [All Other OP (%BC): 46]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE] [APC ($): FEE SCHEDULE]","count":"58","median_amount":487.88,"10th_percentile":390.3,"90th_percentile":487.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 12] [Cardiac Cath (%BC): 12] [Observation (%BC): 12] [Emergency Department (%BC): 12] [Occupational Therapy (%BC): 12] [Physical Therapy (%BC): 12] [Respiratory Services/Therapy  (%BC): 12] [Speech Therapy (%BC): 12] [All Other OP (%BC): 12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 1024.02] [EAPG-Ancillary ($): 1024.02]","count":"67","median_amount":644.21,"10th_percentile":632.04,"90th_percentile":644.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"144","median_amount":487.84,"10th_percentile":468.05,"90th_percentile":517.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":461.45,"10th_percentile":461.45,"90th_percentile":512.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5723] [Bariatric Surgery ($): 21198] [Cardiac Cath ($): 10048] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 11724] [Insertion of Permanent Pacemaker ($): 11724] [Laminectomy/Diskectomy ($): 5654] [Lap Chole ($): 5654] [Laparoscopy ($): 5654] [Lithotripsy ($): 6499] [PTCA ($): 12561] [Observation (%BC): 28.4] [ED Level 1--99281 ($): 502] [ED Level 2--99282 ($): 502] [ED Level 3--99283 ($): 1048] [Urgent Care ($): 712] [Electrophysiology and Mapping Studies ($): 12395] [Gamma Knife ($): 14134] [CT Scan OP ($): 275] [MRI OP ($): 440] [Positron Emission Tomography ($): 1596] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 526] [Peritoneal Dialysis, CAPD, and CCPD ($): 526] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 17.7] [Other Outpatient Implant (%BC): 26.3] [Hyperbarics ($): 1591] [All Other OP (%BC): 16.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6009] [Bariatric Surgery ($): 22259] [Cardiac Cath ($): 10551] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 12310] [Insertion of Permanent Pacemaker ($): 12310] [Laminectomy/Diskectomy ($): 5936] [Lap Chole ($): 5936] [Laparoscopy ($): 5936] [Lithotripsy ($): 6825] [PTCA ($): 13189] [Observation (%BC): 29.9] [ED Level 1--99281 ($): 527] [ED Level 2--99282 ($): 527] [ED Level 3--99283 ($): 1100] [Urgent Care ($): 748] [Electrophysiology and Mapping Studies ($): 13014] [Gamma Knife ($): 14840] [CT Scan OP ($): 289] [MRI OP ($): 462] [Positron Emission Tomography ($): 1676] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 553] [Peritoneal Dialysis, CAPD, and CCPD ($): 553] [Occupational Therapy ($): 132] [Physical Therapy ($): 132] [Speech Therapy ($): 132] [OP High Cost Drugs (%BC): 18.6] [Other Outpatient Implant (%BC): 27.8] [Hyperbarics ($): 1670] [All Other OP (%BC): 16.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":483.4,"10th_percentile":483.0,"90th_percentile":483.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Novanet","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5218] [Ablation ($): 9017] [Bariatric Surgery ($): 17147] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 36894] [Insertion of Permanent Pacemaker ($): 8492] [Joint Replacement-Full/Partial ($): 8074] [Laminectomy/Diskectomy ($): 6260] [PTCA w/ Drug Eluting Stent ($): 26548] [PTCA w/non Drug Eluting Stent ($): 15961] [PTCA w/out stent ($): 12770] [Stereotactic Radiosurgery ($): 35510] [Observation (%BC): 7.9] [Critical Care-99291 ($): 4734] [Urgent Care ($): 234] [Clinic Visit ($): 656] [Cardiac Rehabilitation Therapy ($): 802] [Cardiac Stress Test ($): 1512] [Cardiology ($): 1337] [Echocardiology ($): 623] [EKG/ECG ($): 444] [Electrophysiology Ablation ($): 25537] [Electrophysiology and Mapping Studies ($): 25537] [Holter Monitor/Telemetry ($): 888] [Peripheral Vascular Lab ($): 1426] [EEG ($): 2496] [EMG ($): 881] [Neuropsychological Testing and Biofeedback ($): 1817] [Sleep Studies ($): 1922] [Chemotherapy ($): 2521] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 790] [Radiation Therapy ($): 1512] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1173] [Peritoneal Dialysis, CAPD, and CCPD ($): 1388] [Occupational Therapy ($): 278] [Physical Therapy ($): 278] [Resp. Services/Therapy ($): 470] [Speech Therapy ($): 278] [Ambulance--Land ($): 937] [Hyperbarics ($): 1783] [IV Therapy ($): 790] [Pulmonary Function ($): 855]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3770] [Ablation ($): 6514] [Bariatric Surgery ($): 12386] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 26648] [Insertion of Permanent Pacemaker ($): 6134] [Joint Replacement-Full/Partial ($): 5832] [Laminectomy/Diskectomy ($): 4522] [PTCA w/ Drug Eluting Stent ($): 19176] [PTCA w/non Drug Eluting Stent ($): 11528] [PTCA w/out stent ($): 9224] [Stereotactic Radiosurgery ($): 25648] [Observation (%BC): 5.71] [Critical Care-99291 ($): 3511] [Urgent Care ($): 169] [Clinic Visit ($): 474] [Cardiac Rehabilitation Therapy ($): 579] [Cardiac Stress Test ($): 1093] [Cardiology ($): 965] [Echocardiology ($): 450] [EKG/ECG ($): 320] [Electrophysiology Ablation ($): 18446] [Electrophysiology and Mapping Studies ($): 18446] [Holter Monitor/Telemetry ($): 642] [Peripheral Vascular Lab ($): 1030] [EEG ($): 1803] [EMG ($): 638] [Neuropsychological Testing and Biofeedback ($): 1312] [Sleep Studies ($): 1388] [Chemotherapy ($): 1820] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 572] [Radiation Therapy ($): 1093] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 847.99] [Peritoneal Dialysis, CAPD, and CCPD ($): 1002] [Occupational Therapy ($): 201] [Physical Therapy ($): 201] [Resp. Services/Therapy ($): 338] [Speech Therapy ($): 201] [Ambulance--Land ($): 678] [Hyperbarics ($): 1289] [IV Therapy ($): 572] [Pulmonary Function ($): 617]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 6587] [Ablation ($): 11381] [Bariatric Surgery ($): 21643] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 46567] [Insertion of Permanent Pacemaker ($): 10720] [Joint Replacement-Full/Partial ($): 10190] [Laminectomy/Diskectomy ($): 7900] [PTCA w/ Drug Eluting Stent ($): 33508] [PTCA w/non Drug Eluting Stent ($): 20144] [PTCA w/out stent ($): 16119] [Stereotactic Radiosurgery ($): 44821] [Observation (%BC): 9.95] [Critical Care-99291 ($): 5976] [Urgent Care ($): 296] [Clinic Visit ($): 828] [Cardiac Rehabilitation Therapy ($): 1012] [Cardiac Stress Test ($): 1909] [Cardiology ($): 1686] [Echocardiology ($): 786] [EKG/ECG ($): 561] [Electrophysiology Ablation ($): 32233] [Electrophysiology and Mapping Studies ($): 32233] [Holter Monitor/Telemetry ($): 1122] [Peripheral Vascular Lab ($): 1799] [EEG ($): 3149] [EMG ($): 1115] [Neuropsychological Testing and Biofeedback ($): 2294] [Sleep Studies ($): 2426] [Chemotherapy ($): 3182] [Nuclear Medicine Fee Schedule: FEE SCHEDULE] [Oncology ($): 998] [Radiation Therapy ($): 1909] [CT Scan OP ($): FEE SCHEDULE] [MRI OP ($): FEE SCHEDULE] [Imaging Services ($): FEE SCHEDULE] [Mammography-Diagnostic Fee Schedule: FEE SCHEDULE] [Mammography-Screening Fee Schedule: FEE SCHEDULE] [Positron Emission Tomography ($): FEE SCHEDULE] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 1483] [Peritoneal Dialysis, CAPD, and CCPD ($): 1751] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Resp. Services/Therapy ($): 590] [Speech Therapy ($): 352] [Ambulance--Land ($): 1183] [Hyperbarics ($): 2251] [IV Therapy ($): 998] [Pulmonary Function ($): 1078]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 40 Maximum Reimbursement 6691] [Lithotripsy ($): 6633] [Observation-Per Hour: 179 Maximum Reimbursement 4943] [Emergency Department ($): 951] [Mental Health-Intensive ($): 349] [Mental Health-Partial Hospitalization ($): 669] [OP ECT Mental Health ($): 832] [Other Outpatient Implant ($): 0 Charge Threshold 1000 (%BC): 60] [All Other OP (%BC): 60]","count":"43","median_amount":3798.44,"10th_percentile":3597.56,"90th_percentile":3997.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":461.46,"10th_percentile":461.46,"90th_percentile":461.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"First Health Medical Rental Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":53.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 27]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Psych-Per Diem: 700]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Behavioral Health Services","plan_name":"Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1118] [Psych-Per Diem: 1117]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene Wellcare","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healthspring Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Healtspring Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS). Available, referenceable Medicare logic found here: https://webpricer.cms.gov]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Open Access Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6289] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 6699 Days: 3 Additional Days: 2120] [Normal vag. Del. 2 day stay-Case Rate: 4920 Days: 2 Additional Days: 2120] [Nursery  Level 1- Boarder-Per Diem: 1140] [Nursery  Level 2-Per Diem: 2077] [Nursery  Level 3-Per Diem: 2686] [Nursery  Level 4-NICU-Per Diem: 3418] [Rehab-Per Diem: 2197] [SNF-Per Diem: 1130] [IP High Cost Drugs (%BC): 17.7] [IP Prosthetics/Implants/Devices (%BC): 26.3] [Bariatric Surgery-Case Rate: 21198]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 509182 | Total % of Charge: 6603] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 7034 Days: 3 Additional Days: 2226] [Normal vag. Del. 2 day stay-Case Rate: 5166 Days: 2 Additional Days: 2226] [Nursery  Level 1- Boarder-Per Diem: 1197] [Nursery  Level 2-Per Diem: 2181] [Nursery  Level 3-Per Diem: 2820] [Nursery  Level 4-NICU-Per Diem: 3589] [Rehab-Per Diem: 2307] [SNF-Per Diem: 1187] [IP High Cost Drugs (%BC): 18.6] [IP Prosthetics/Implants/Devices (%BC): 27.8] [Bariatric Surgery-Case Rate: 22259]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Phcs All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simpra","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Payer Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6077] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 12530 Days: 4 Additional Days: 2864] [Normal vag. Del. 2 day stay-Case Rate: 7161 Days: 2 Additional Days: 2864] [Normal Newborn-Per Diem: 853] [Lower Level Neonate-Per Diem: 3222] [Higher Level Neonate-Per Diem: 5369] [Severe Level Neonate-per diem: 5369] [Rehab-Per Diem: 1889] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Iex Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 4389] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 9050 Days: 4 Additional Days: 2069] [Normal vag. Del. 2 day stay-Case Rate: 5172 Days: 2 Additional Days: 2069] [Normal Newborn-Per Diem: 616] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3878] [Severe Level Neonate-per diem: 3878] [Rehab-Per Diem: 1365] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Options Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 7671] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15816 Days: 4 Additional Days: 3616] [Normal vag. Del. 2 day stay-Case Rate: 9039 Days: 2 Additional Days: 3616] [Normal Newborn-Per Diem: 1075] [Lower Level Neonate-Per Diem: 4065] [Higher Level Neonate-Per Diem: 6778] [Severe Level Neonate-per diem: 6778] [Rehab-Per Diem: 2384] [IP High Cost Drugs ($): 0 Charge Threshold 315203 (%BC): 1.28]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Behavioral Health Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1158] [Psych-Per Diem: 1158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Optum Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 1000] [Psych-Per Diem: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Health","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 4943] [Surgical-Per Diem: 4943] [ICU-Per Diem: 5351] [CCU-Per Diem: 5351] [C-Section-Case Rate: 8799] [Normal Vaginal Delivery-Case Rate: 6896] [Alcohol/ Chemical Dependency-Per Diem: 1320] [Psych-Per Diem: 1320] [Rehab-Per Diem: 2313] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1000 (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Viva Helath","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Visualization 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